GENERAL PROFESSIONAL IV (MED-QUEST DATA ANALYST) - EWA, OAHU

The General Professional IV independently performs complex professional work which involves considerable research and analysis of a variety of issues, identification of various options and recommendation of the most viable solution.

This position is located in the Department of Human Services, Med-QUEST Division (MQD), Finance Office, and is responsible for conducting data analysis in support of the Division’s statewide surveillance and utilization control program of program integrity functions to identify potential fraud and abuse by Medicaid program providers.

The duties and responsibilities of this position include analyzing and evaluating surveillance and utilization review subsystem reports, providers’ records, claims and other related materials, current trends in provider abuse and fraud, complaints against providers, etc., to determine the scope, parameters and variables for data analyses; analyzing and interpreting any identified anomalies, aberrancies, outliers, etc., and verifying or corroborating with data, records, claims, files, program providers, etc., to determine whether the utilization of services and providers’ claims and billings represent potential fraud and abuse; referring cases involving possible fraud and abuse for preliminary investigation by MQD investigative staff; preparing summaries and reports with data; maintaining accurate and updated fraud and abuse reports, records, and referrals; and performing other related duties as assigned., The Department of Human Resources Development (HRD) will use electronic mail (email) to notify applicants of important information relating to the status and processing of their applications as part of our ongoing efforts to increase operational efficiency, promote the conservation of green resources, and minimize delays and costs.

Please ensure that the email address and contact information you provide is current, secure, and readily accessible to you. We will not be responsible in any way if you do not receive our emails or fail to check your email-box in a timely manner. In addition, please be aware that you may no longer receive notification about applications submitted if you choose to disable the Job Application Emails feature in your Account Settings.

The State of Hawaii requires all persons seeking employment with the government of the State shall be citizens, nationals, or permanent resident aliens of the United States, or eligible under federal law for unrestricted employment in the United States. Basic Education: Bachelor’s degree from an accredited four-year college or university.

General Experience: One (1) year of responsible professional work experience which required a high degree of analytical skill. Such experience must have involved gathering, evaluating and analyzing facts and other pertinent information required to resolve problems and/or to determine and recommend appropriate courses of action; demonstrated the ability to elicit information orally and in writing; reading, comprehending, interpreting and evaluating technical subjects, analysis or proposals; and applying problem solving methods and techniques, such as defining and analyzing problems, identifying alternative courses of action, using judgment in determining appropriate alternatives; and preparing clear and concise written reports and recommendations for action.

The experience must have been comparable to the General Professional III in the State service and must have provided the knowledge, skills and abilities required to perform the duties and responsibilities of the position to be filled. The General Professional III independently performs moderately complex professional work which involves performing research and analysis in order to identify problems and recommend appropriate solutions in accordance with established policies, procedures, standards, guidelines, techniques and methods.

Selective Certification Requirement (Med-QUEST Data Analyst Experience): In order to effectively perform the duties and responsibilities of this position, applicants must possess demonstrated knowledge of methods and tools of data analysis such as using data mining, data or database queries, statistically valid samplings, etc., of information or data such as health care providers’ billings, diagnosis codes, procedural codes, health care provider information, etc.; statistical and quantitative analysis methods to determine cause and effect; computer applications including data analysis and statistical applications (e.g., LexisNexis Intelligent Investigator, IBM Cognos, SAS, Access, Excel, etc.); and the skill to interpret and summarize such data, information and findings; prepare clear and concise reports of findings; and organize large data sets with accuracy and attention to detail.

Therefore, certification of eligibles for this position shall be restricted to those applicants who meet the minimum qualification requirements for the class General Professional IV. In addition, at least one (1) year of General Experience required for the class MUST demonstrate the knowledge and skills described above.

Such Med-QUEST Data Analyst Experience may have been gained concurrently with, or in a separate capacity from, the aforementioned General Experience.

Supervisory Aptitude: Supervisory aptitude rather than actual supervisory experience may be accepted. This requirement will be considered to have been met when there is strong affirmative evidence of the necessary supervisory abilities and/or potential.

$5,527 - $6,728 a month - Permanent, Full-time, Pulled from the full job description

• Mileage reimbursement
• Loan forgiveness
• Retirement plan
• Vision insurance
• Flexible spending account
• Life insurance
• Disability insurance, Salary: $5,527 to $6,728 per month (SR-22, Step D to I)