**This position is exempt from the State Human Resources Act**
Recruitment Range: $70,000- $100,000/ Salary Grade: 81
The North Carolina Department of Health and Human Services (DHHS) is one of the largest, most complex agencies in the state, with approximately 18,000 employees. It is responsible for ensuring the health, safety and well-being of all North Carolinians, providing human service needs for special populations including individuals who are deaf, blind, developmentally disabled and mentally ill, and helping North Carolinians achieve economic independence.
The Division of Medical Assistance (DMA) arranges and reimburses for health care services for the most vulnerable North Carolina residents. With a budget of nearly $14 billion, DMA serves 1.8 million low-income parents, children, seniors and people with disabilities through the N.C. Medicaid and N.C. Health Choice for Children programs.
Program Integrity (PI) is responsible for the detection and prevention of abuse and fraud in the delivery and cost of provider services in the Medicaid and Health Choice Programs. This Data Analytics Supervisor position is responsible for managing the utilization of current data applications and recommending alternative systems as needed to reduce fraud and abuse. This position, in coordination with other managers, identifies data needed to review, analyze, and evaluate provider business practices to identify potential fraud waste and abuse through data queries and gap analysis.
Job Specific Responsibilities
Manage the continuing deployment, development, and ongoing support of clinical application software necessary to detect and prevent fraud waste and abuse in the Medicaid and Health Choice programs
Interface with PI staff, groups or individuals and/or vendors to identify and author common queries to be used by staff
Utilize internal and external information such as the OIG work plan, legislative mandates and total provider type dollar spend to create an annual analytics work plan
Manage the development of unique queries based on specific program needs
Execute reporting and querying of data marts
Develop dashboard reports as well as report cards reflecting vendor performance
Provide internal and external support services for various PI applications
Manage the completion of data requests utilizing standard system software (e.g. Microsoft Office Suite, etc.), Truven J-SURS, Truven Advantage Suite, IBM Fraud and Abuse Management System (FAMS), as well as the Client Services Data Warehouse
Train and develop staff; effectively manage staff to meet goals and work needs; monitor staff performance and provide effective feedback and guidance to staff
Knowledge, Skills and Abilities / Competencies
Extensive knowledge of reporting and querying of data marts
Demonstrated ability to successfully manage multiple priorities and deadlines;
Proven ability to collect data and analyze healthcare data
Thorough knowledge of applicable business information systems, testing methodologies, training, business system analysis, and/or other applicable systems.
Demonstrated ability to exercise creative and critical thinking in evaluating situations and developing solutions
Proven ability to make independent decisions and take action on matters affecting projects or client base
Demonstrated ability to develop reports or other communication to support legal cases to recover funds
Demonstrated ability to synthesize information into succinct, concise, and logical summaries and reports
Ability to facilitate stakeholder sessions to achieve consensus and collaboration.
Proven ability to develop, monitor, and communicate changes to project scope, project plans, timelines, status, issues, and risks for moderately complex projects, or subsets of complex projects
Advanced Microsoft Suite skills
Demonstrated success in the ability to lead others as well as lead projects by projecting a positive attitude and motivating staff.
Medicaid and NC Analytics experience
Experience working with large amounts of healthcare data and systems
Experience developing dashboard reports and/or report cards reflecting vendor performance
Prior direct or indirect supervisory/management experience preferably in a healthcare IT environment.
Minimum Education and Experience Requirements
Bachelor's degree in a discipline related to the area of assignment; or equivalent combination of training and experience. All degrees must be received from appropriately accredited institutions. If there are no qualified applicants at the posted competency level, management may consider applicants at a lower competency level.
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