Description
General Summary of Position
POSITION SUMMARY
The Enrollment/Encounter Data Steward is responsible for managing the reconciliation and integrity of enrollment and encounter data. This role plays a critical part in ensuring accurate and timely submission of enrollment data to delegated vendors, and in coordinating with a BPaaS (Business Process as a Service) vendor to address and resolve encounter data rejections. Collaboratea with the BPaaS vendor to monitor, analyze, and resolve encounter data rejections. Ensures rejected encounters are corrected and resubmitted in accordance with CMS and/or state regulatory requirements. Tracks and reports on encounter submission status, trends, and resolution metrics. Reconciles membership and enrollment data across internal systems and delegated entities. Identifies and resolves discrepancies in enrollment files to ensure data accuracy and timelines. Supports monthly and ad-hoc reconciliation cycles with internal stakeholders and external vendors.
The ideal candidate will possess strong operational knowledge, hands-on experience working with EDI files (including 834, 837I, 837P, and NCPDP), and a proactive mindset to drive data accuracy and regulatory compliance.
Education: Bachelor's degree in Computer Science, Public Health, Healthcare Informatics, Health Administration, Statistics, or other relevant discipline required
PRIMARY DUTIES AND RESPONSIBILITIES
Serves as primary point of contact with MDH/DHCF on encounter data issues. Reports, tracks, resolves and trends enrollment discrepancies to regulatory partners. This includes issues identified by BPaaS vendor and/or other delegated vendors.
Completes complex root cause analysis and research of encounter errors, partners with BPAAS vendor to generate corrections and resubmission in a timely manner.
Accesses and analyzes data using a variety of tools such as, Tableau, MS Excel, SQL to monitor and create monthly, quarterly and ad-hoc reports for management review and use.
Collaborates with other departments and vendors to identify missing data, errors or other anomalies and works with them to correct these encounter data errors, gather necessary information and provide guidance on regulatory reporting needs.
Reconciles enrollment data and encounter data within the EDW and collaborates with delegated vendors to confirm accuracy.
Reviews and identifies trends and variances in encounter data and reporting. Researches findings and determines the appropriateness of elevating identified issues to leadership for further review/evaluation/action.
Develops and maintains key relationships with all impacted business areas and external partners in support of Interoperability compliance.
This position has a hiring range of $70,428 - $131,310
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