Source: New York State Jobs · Bespree is not the employer.
Lead and direct unit activities, including establishing goals, priorities, and operational procedures; provide technical guidance and mentorship to staff on graph databases, Python, AI/ML, and cloud analytics
Design and maintain cloud-based graph database architectures to integrate provider, claims, and encounter data; define data models and schemas to reveal provider networks, referral patterns, and billing relationships indicative of FWA
Develop and implement AI/ML models for FWA detection, including anomaly detection, predictive risk scoring, natural language processing, and network analysis to uncover collusive fraud schemes
Build and maintain Python-based ETL pipelines and analytical tools for loading data into graph databases and Snowflake; develop scripts for pattern detection, risk scoring, data quality analysis, and automated alerting
Architect scalable, secure cloud infrastructure using Snowflake and graph database platforms for real-time and batch fraud detection processing
Research and evaluate emerging AI technologies for Medicaid FWA applicability; develop proof-of-concept solutions and present findings and recommendations to management
Collaborate with program integrity units, program areas, and technical teams to translate investigative and program integrity needs into technical specifications
Develop and maintain FWA dashboards, reporting tools, and alert systems; provide management with analytics, risk assessments, visualizations, and actionable intelligence to support program integrity decisions
Maintain documentation for database schemas, AI/ML models, algorithms, data pipelines, and cloud architecture; establish coding standards and best practices for the unit
Review and resolve data quality issues, system deficiencies, and integration challenges impacting FWA detection capabilities
Perform the full range of supervisory responsibilities over Data Analysts and technical staff within the unit.
Nine years of experience* in data visualization, and statistical models and data mining tools
*Substitution: An associate’s degree may substitute for two years of general experience; or a bachelor’s degree may substitute for four years of general experience. A master’s degree in data or computer science, informatics, economics, statistics, mathematics, or a related field, may substitute for one year of general experience; or a Ph.D. in these fields may substitute for two years of general experience.
Preferred Qualifications: Proficiency in Python programming for data analysis, automation, ETL development, and machine learning applications. Experience with Medicaid or Medicare claims, encounter, and provider data systems, including knowledge of FWA detection methodologies and healthcare coding systems. Supervisory experience leading technical or data analytics teams, with a track record of standing up new programs or units. Familiarity with HIPAA, healthcare data privacy requirements, and state or federal government environments
When reviewing qualifications, omissions and vagueness cannot be interpreted in the candidate’s favor. Candidates are responsible for providing accurate and clear descriptions of their experience demonstrating how they meet the minimum qualifications.
We offer a work-life balance and a generous benefits package, worth 65% of salary, including:
The NYS Department of Health is committed to making New York a safer, healthier, and more equitable place to live. Understanding health equity, social determinants of health and health disparities is critical to accomplish our goal of eliminating health disparities. For more information on the NYS Department of Health’s Mission, Vision, Values and Strategic Plan, please visit: https://health.ny.gov/commissioner/index.htm
If you require reasonable accommodation to complete a job application, a job interview or to otherwise participate in the hiring process, please contact by phone 518-486-1812 or email doh.sm.Reasonable.Accommodation@health.ny.gov to make a request.
The NYS Department of Health does not participate in E-Verify and does not sponsor visa applications.
For new State employees appointed to graded positions, the annual salary is the hiring rate of the position (beginning of the salary range). Promotion salaries are calculated by the NYS Office of the State Comptroller in accordance with NYS Civil Service Law, OSC Payroll rules and regulations, and negotiated union contracts.
New York State agencies, departments, and public authorities provide services across healthcare, engineering, administration, public safety, the trades, and other areas.
Source: New York State Jobs · Bespree is not the employer.
Lead and direct unit activities, including establishing goals, priorities, and operational procedures; provide technical guidance and mentorship to staff on graph databases, Python, AI/ML, and cloud analytics
Design and maintain cloud-based graph database architectures to integrate provider, claims, and encounter data; define data models and schemas to reveal provider networks, referral patterns, and billing relationships indicative of FWA
Develop and implement AI/ML models for FWA detection, including anomaly detection, predictive risk scoring, natural language processing, and network analysis to uncover collusive fraud schemes
Build and maintain Python-based ETL pipelines and analytical tools for loading data into graph databases and Snowflake; develop scripts for pattern detection, risk scoring, data quality analysis, and automated alerting
Architect scalable, secure cloud infrastructure using Snowflake and graph database platforms for real-time and batch fraud detection processing
Research and evaluate emerging AI technologies for Medicaid FWA applicability; develop proof-of-concept solutions and present findings and recommendations to management
Collaborate with program integrity units, program areas, and technical teams to translate investigative and program integrity needs into technical specifications
Develop and maintain FWA dashboards, reporting tools, and alert systems; provide management with analytics, risk assessments, visualizations, and actionable intelligence to support program integrity decisions
Maintain documentation for database schemas, AI/ML models, algorithms, data pipelines, and cloud architecture; establish coding standards and best practices for the unit
Review and resolve data quality issues, system deficiencies, and integration challenges impacting FWA detection capabilities
Perform the full range of supervisory responsibilities over Data Analysts and technical staff within the unit.
Nine years of experience* in data visualization, and statistical models and data mining tools
*Substitution: An associate’s degree may substitute for two years of general experience; or a bachelor’s degree may substitute for four years of general experience. A master’s degree in data or computer science, informatics, economics, statistics, mathematics, or a related field, may substitute for one year of general experience; or a Ph.D. in these fields may substitute for two years of general experience.
Preferred Qualifications: Proficiency in Python programming for data analysis, automation, ETL development, and machine learning applications. Experience with Medicaid or Medicare claims, encounter, and provider data systems, including knowledge of FWA detection methodologies and healthcare coding systems. Supervisory experience leading technical or data analytics teams, with a track record of standing up new programs or units. Familiarity with HIPAA, healthcare data privacy requirements, and state or federal government environments
When reviewing qualifications, omissions and vagueness cannot be interpreted in the candidate’s favor. Candidates are responsible for providing accurate and clear descriptions of their experience demonstrating how they meet the minimum qualifications.
We offer a work-life balance and a generous benefits package, worth 65% of salary, including:
The NYS Department of Health is committed to making New York a safer, healthier, and more equitable place to live. Understanding health equity, social determinants of health and health disparities is critical to accomplish our goal of eliminating health disparities. For more information on the NYS Department of Health’s Mission, Vision, Values and Strategic Plan, please visit: https://health.ny.gov/commissioner/index.htm
If you require reasonable accommodation to complete a job application, a job interview or to otherwise participate in the hiring process, please contact by phone 518-486-1812 or email doh.sm.Reasonable.Accommodation@health.ny.gov to make a request.
The NYS Department of Health does not participate in E-Verify and does not sponsor visa applications.
For new State employees appointed to graded positions, the annual salary is the hiring rate of the position (beginning of the salary range). Promotion salaries are calculated by the NYS Office of the State Comptroller in accordance with NYS Civil Service Law, OSC Payroll rules and regulations, and negotiated union contracts.
New York State agencies, departments, and public authorities provide services across healthcare, engineering, administration, public safety, the trades, and other areas.