Forensic Data Specialist I/II at Pennsylvania Office of Attorney General, PA

About the Department

Section:                    Medicaid Fraud Control Section/Criminal Law Division

Class:                        Forensic Data Specialist I/II

Location:                  Harrisburg or Norristown

Telework:                 This position will report to the headquartered location a minimum of 2 days per week. You 

                                  may have the opportunity to telework the remainder of the week, if desired and based on business need.

Position Type:          Full-time, Non-civil service, Non-union

Work Hours:             8:30 – 5:00

Salary Range:           Forensic Data Specialist I – Starting salary of $57,487

                                   Forensic Data Specialist II – Starting salary of $65,741

Basic Function

This position works in partnership with Office of Attorney General attorneys, agents, auditors, and analysts on cases, referrals, data mining, and global matters alleging Medicaid fraud. An employee in this position performs data analytics work which involves the formulation and implementation of database queries, the construction and analysis of large datasets to identify statistical outliers or anomalies, and data compilation and presentation in support of health care fraud investigations. This employee will work closely with attorneys, agents, auditors, and analysts to refine data analysis of health care billing pertinent to criminal and/or regulatory investigations into the Medicaid Fraud and Abuse amendments, the Neglect of Care-Dependent Persons Act, and other applicable state and federal regulations.

An employee in this position will access PA Department of Human Services (DHS) data warehouses to query and extract data as needed for case work. Additionally, this position requires cooperative team analysis of ongoing trends in Medicaid cost and provider reimbursements to develop and identify new strategies for data analysis in support of evolving approaches to identifying and proving Medicaid fraud. The position also requires the employee to research and understand data maintained by DHS or Managed Care Organizations (MCOs) to initiate, monitor, and deliver requested data; update and maintain resource records/organizational process assets; and perform complex analysis, reporting, and presentations for cases.

Position Duties

• Queries DHS data warehouses in order to deliver claims and Electronic Visit Verification (EVV) data and analysis reports for matters and cases while ensuring the protection of private health information

• Compiles and parses large datasets for review by case agents and for courtroom presentations using Excel, Access, or similar data systems

• Consults with attorneys, agents, auditors, and analysts regarding parameters for obtaining data and conducting analysis

• Participates in conference calls and meetings related to case investigation strategies and provides input regarding data retrieval and analysis

• Develops new analytical methodologies to available data to identify, capture, and present statistical anomalies within Medicaid billing data

• Performs quality control and assurance of analysis and data deliveries through peer review using inspection, sampling, process analysis, and code review

• Mentors Medicaid analysts and provides direction related to claims analysis and data retrieval from the DHS data warehouses

• Continues to strengthen programming skills and improve data queries and analysis

• Testifies as a witness in court proceedings resulting from data provision as requested

• Assists with informational sessions on data sources, tools, and analytics

Minimum Qualifications

Forensic Data Specialist I

• An Associate’s degree from an accredited institution in information technology, data science, computer science, statistics, or a related program and two years of data analytics or programming language experience OR

• A Bachelor’s degree from an accredited institution in information technology, data science, computer science, statistics, or a related program OR

• Four years of data analytics or programming language experience

Forensic Data Specialist II

• An Associate’s degree from an accredited institution in information technology, data science, computer science, statistics, or a related program and four years of data analytics or programming language experience OR

• A Bachelor’s degree from an accredited institution in information technology, data science, computer science, statistics, or a related program and two years of data analytics or programming language experience OR

• A Master’s degree from an accredited institution in information technology, data science, computer science, statistics, or a related program OR

• Six years of data analytics or programming language experience

Other Qualifications

• Skills in computer programming including experience in or knowledge with SQL, R, SAS, Python, or similar programming languages used for data extraction or analysis

• Ability to formulate analytical database queries and strategies in support of investigative objectives

• Skills in computer use including proficiency with Microsoft Office Suite, especially Excel and Access, and data management systems

• Familiarity with spreadsheet, database, or data management systems

• Understanding of privacy and data protection laws

• Skills in project management and effective use of resources including documenting tasks on a timely and accurate basis, budgeting resources, and managing completion dates

• Ability to use judgment, tact, and discretion

• Ability to communicate effectively, both verbally and in writing

• Ability to elicit information from attorneys and agents

• Ability to maintain records, and prepare reports and correspondence related to the work

• Ability to effectively testify as a witness in all courts

• Ability to organize work, establish priorities, and maintain good interpersonal relations and communications with all staff, outside agencies, and the public

• General knowledge of the functioning and processes of the civil/criminal justice system

• The ability to research data sources and tools to implement into investigations and educate attorneys, agents, auditors, and analysts on how to effectively utilize these resources

• Experience with medical and health care billing processes and data systems

• Knowledge of the Medicaid program

• Knowledge of geospatial analysis programs such as ArcGIS