Enroll/Encounter Data Steward Job Listing at MedStar Medical Group in Washington, DC (Job ID req48549)

Description

General Summary of Position
Ensures that accurate and complete enrollment and encounter data resides within the health plan Enterprise Data Warehouse (EDW) and is successfully transmitted to the Maryland Department of Health (MDH) and/or Department of Health Care Finance (DHCF). Researches and resolves enrollment discrepancies identified by the health plan. This includes identifying and reporting individuals who no longer meet eligibility requirements (duplicate members, moved out of state, deceased etc). Ensures downstream vendors have accurate eligibility and monitors enrollment reconciliation process between BPaaS vendor and the delegated vendors. Includes working with BPaaS vendor to resolve eligibility issues. Evaluates encounter data and identifies errors, including those created by operational, claims, and eligibility processes. Researches, analyzes, summarizes, and categorizes all types of encounters based on response files from MDH/DC DHCF, as appropriate. Works closely with other internal departments, delegated vendors, and government agencies to monitor and communicate that the paid and denied claims adjudicated are completely and accurately submitted and processed to the MDH and/or DHCF in a timely manner, as appropriate. Needs to understand the overall data, process flows, and provider data specifications used within Maryland/DC, and works with the Information Technology, Medical Economics and Analytics teams to create targeted and ongoing reports to track data accuracy and timeliness. Works under moderate supervision. Serves as the business lead for Interoperability requirements in Maryland/DC. This includes managing the relationships with the delegated vendor hosting the Interoperability software and managing the onboarding of third-party applications. We recruit, retain, and advance associates with diverse backgrounds, skills, and talents equitably at all levels.

Primary Duties and Responsibilities

Minimum Qualifications
Education

• High School Diploma or GED or equivalent required or
• Bachelor's degree in Computer Science, Public Health, Healthcare Informatics, Health Administration, Statistics, or other relevant discipline preferred

Experience

• 3-4 years 4 years of related experience required and
• Experience performing encounter data and enrollment reconciliations in a health plan organization, healthcare claims data, health plan enrollment data, resolving data reconciliation/integrity issues. required and
• Experience working with state medicaid agencies related to enrollment and encounter data errors. required and
• Experience with management and fitness of data elements within an enterprise data warehouse for both content and metadata. required

Knowledge, Skills, and Abilities

• Knowledge of encounter data processes, files, etc.
• Advanced proficiency in personal computer programs, including MS Excel required and enterprise database programs (e.g. SQL).
• Proficiency in Tableau.
• Familiarity with a data warehouse environment required.
• Knowledge of medical terminology and/or experiences with CPT and ICD-10 coding.
• Ability to identify basic problems and procedural irregularities, collect data, establish facts and draw valid conclusions.
• Strong aptitude for critical thinking and demonstrated data skills.
• Excellent verbal and written communication skills.
• Detail oriented; able to work independently and set priorities.
• Knowledge of FHIR Data Interoperability via APIs.

This position has a hiring range of $70,428 - $131,310