Enroll/encounter Data Steward

3 weeks ago

Washington, United States MEDSTAR HEALTH Full time

**General Summary of Position**

**Primary Duties and Responsibilities**
- Ensures compliance with policies and procedures and governmental/accreditation regulations.
- Reconciles enrollment data and encounter data within the Enterprise Data Warehouse.
- Reconciles enrollment data with delegated vendors
- Serves as primary point of contact with MDH on encounter data issues. Reports, tracks, resolves and trends enrollment discrepancies to MDH. This includes issues identified by BPaaS vendor and/or other delegated vendors.
- Retrieves, compiles, reviews, and ensures the accuracy of encounter data from the EDW and delegated vendor sources, using an 837-file format. Completes complex root cause analysis and research of encounter errors to generate corrections in a timely manner to provide an accurate picture of medical expense and avoid penalties from the State.
- Accesses data from the EDW using a variety of tools such as, Tableau, MS Excel, SQL. Works closely with IT and Medical Economics to ensure data completeness, data accuracy and data availability. Monitors encounter data integrity of various databases and creates monthly, quarterly and ad-hoc reports.
- Summarizes large volumes of encounter data in analytical reports that include tables, graphs, qualitative and quantitative analyses for management review and use.
- 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.
- 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.
- Manages the Interoperability process in Maryland to ensure compliance with all state and federal regulations. Serves as data steward for Interoperability integration projects, providing accurate and timely requirements, prioritization, testing and documentation.
- Ensures delegated vendor adheres to all Interoperability requirements and monitors system functionality. Manages all system upgrades and enhancements
- Assist in the development and implementation of processes to improve data quality within the data class
- 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.

**Minimum Qualifications**
**Education**
- High School Diploma or GED required or
- equivalent required and
- Bachelor's degree in Computer Science, Public Health, Healthcare Informatics, Health Administration, Statistics, preferred 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.

**Why MedStar Health?**
At MedStar Health, we understand that our ability to treat others well begins with how we treat each other. We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered. We live up to this promise through:

- **Strong emphasis on teamwork - **our associates feel connected to each other and our mission as an organization. In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.
- **Strategic focus on equity, inclusion, & diversity - **we are committed to equity for all people and communities. We continue to build a diverse and inclusive workplace where people feel a s

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