Senior Statistician Federal Health (CMS)

At Commence were the start of a new age of data-centric transformation elevating health outcomes and powering better more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers technology that advances performance and clinical expertise that builds trust to create a more efficient path to quality care.

With human-centered healthcare-relevant and value-based solutions we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose straightforward communication and clinical domain expertise Commence cuts straight to better care.

The Senior Statistician is the subject matter expert responsible for the statistical sampling methodology and overpayment extrapolation function on a CMS contract. This role designs the sampling methodology validates the sample frame executes the extrapolation calculations and produces all supporting documentation. The Senior Statistician works in close coordination with the Project Manager Medical Review Manager and legal/compliance staff and interfaces directly with CMS on sampling design approvals and methodology questions. This is a technically demanding legally scrutinized role requiring deep expertise in probability sampling theory and applied healthcare data analysis.

Essential Duties and Responsibilities

• Design document and execute probability sampling methodologies for Medicare claims review activities in accordance with IOM 100-8 and applicable CMS guidance.
• Perform overpayment extrapolation calculations projecting sample-level findings to the full universe of claims; validate all inputs outputs and assumptions with supporting statistical documentation.
• Validate sample frames confirm universe definitions and assess sample integrity prior to initiating review activities; identify and resolve frame errors duplicate claims or data anomalies.
• Prepare clear technically precise written reports and workpapers documenting all sampling and extrapolation methodology decisions suitable for submission to CMS and use in administrative appeals.
• Support the defense of extrapolation findings at Administrative Law Judge (ALJ) hearings; provide expert testimony or written declarations on sampling methodology as required.
• Extract process and analyze large complex Medicare claims data files from multiple healthcare data sources; apply data mining analysis of variance and related analytical techniques to identify patterns and support review targeting decisions.
• Collaborate with the Project Manager Medical Review Manager and legal/compliance staff on review targeting strategy data requests and CMS reporting requirements related to statistical workstreams.
• Stay current with evolving CMS statistical sampling guidance Medicare claims data structures and relevant regulatory or policy developments that affect sampling design or extrapolation methodology.

Qualifications

• Masters degree in Statistics from an accredited institution required; no substitutions accepted for this credential.
• Minimum 3 years of professional experience in probability sampling design and extrapolation estimation methods including application to complex large-scale datasets.
• Demonstrated proficiency developing statistical and data information from a variety of healthcare data sources including Medicare claims data environments (e.g. CMS Standard Analytic Files MedPAR or equivalent).
• Proficiency with statistical analytic tools (e.g. SAS R SPSS or equivalent); experience with data mining techniques analysis of variance and manipulation of large complex data files.
• Familiarity with IOM 100-8 statistical sampling methodology guidance and its application to Medicare overpayment extrapolation in a contractor environment.

Preferred Qualifications

• Prior experience performing Medicare overpayment extrapolation on a CMS medical review or program integrity contract; direct knowledge of CMS extrapolation approval processes strongly preferred.
• Experience providing expert statistical testimony or written declarations in Administrative Law Judge (ALJ) proceedings or other administrative appeals involving extrapolation methodology challenges.
• In-depth working knowledge of IOM 100-8 including stratified random sampling design mean-per-unit estimation and lower confidence limit (LCL) methodology as applied to Medicare payment error rate calculations.
• Ph.D. in Statistics or Biostatistics or equivalent advanced training in survey sampling methodology is a plus.

Work Environment/Physical Demands

The work environment and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This is a remote position. While performing the duties of this job the employee regularly works in a climate-controlled environment. Candidates must be able to sit read work on a computer and watch a computer screen for extended periods of time. Occasionally required to stand walk use hands and fingers kneel or crouch.

Commence is an equal employment opportunity for employer. All personnel processes are merit-based and applied without discrimination on the basis of race color religion sex sexual orientation gender identity marital status age disability national or ethnic origin military and veteran status or any other characteristic protected by applicable law.

is committed to providing equal employment opportunities to all applicants including individuals with disabilities. If you require reasonable accommodation to participate in the application process due to a disability please contact Human Resources at or .Please note that unless you are requesting an accommodation all applications must be submitted through our online application system.