Enroll/Encounter Data Steward

1 week ago

Washington, Washington, D.C., United States MEDSTAR HEALTH Full time
Ensures that accurate and complete enrollment and encounter data resides within the health plan Enterprise Data Warehouse (EDW) and is successfully transmitted to the DC 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). 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 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 DHCF in a timely manner, as appropriate. Needs to understand the overall data, process flows, and provider data specifications used within the District of Columbia, 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.

We recruit, retain, and advance associates with diverse backgrounds, skills, and talents equitably at all levels.
EducationHigh School Diploma or GED Required or equivalent Required andBachelor's degree in Computer Science, Public Health, Healthcare Informatics, Health Administration, Statistics, Preferred or other relevant discipline Preferred Experience3-4 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 AbilitiesKnowledge 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.Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.Ensures compliance with policies and procedures and governmental/accreditation regulations.Reconciles enrollment data and encounter data within the Enterprise Data Warehouse.Reports, tracks, resolves and trends enrollment discrepancies to DHCF. This includes issues identified by TPA and/or other delegated vendors.Completes complex root cause analysis and research of errors to generate corrections in a timely manner to provide an accurate picture of medical expense and avoid penalties from the State.Develops or specifies and monitors routine and custom data quality reports to identify areas of data quality issues.Retrieves, compiles, reviews, and ensures the accuracy of encounter data from the EDW and delegated vendor sources, using an 837-file format.Accesses data from the EDW using a variety of tools such as, Tableau, MS Excel, SQL.Summarizes large volumes of encounter data in analytical reports that include tables, graphs, qualitative and quantitative analyses for management review and use.Works closely with IT and Medical Economics to ensure data completeness, data accuracy, and data availability.Assists in the development of reports and projects, including documenting methodology, protocols, analysis, and design. Recommends and implements efficient means of data collection and maintenance.Programs using SQL or other appropriate software to generate reports based on input/direction from management and other report users.Collaborates with other departments and vendors to identify missing data, errors or other anomalies; works with them to correct these encounter data errors, gather necessary information and provide guidance on regulatory reporting needs.Monitors encounter data integrity of various databases and create monthly, quarterly and ad-hoc reports.Initiates and maintains internal contacts to secure current/correct encounter data necessary for clear presentations of all reports, special projects, etc.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.Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings, serves on committees and represents the department and hospital/facility in community outreach efforts as appropriate.Serves as the primary point of contact to DHCF on all encounter data issues and reporting matters.Performs special projects and other duties, as needed.

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