Enroll/Encounter Data Steward

1 month ago

Washington, United States MedStar Health Full time
General Summary of PositionEnsures 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 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 vendorand/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 Collaborates with MedStar Health IT security in the vetting and approval of third party applications for Interoperability. 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 GEDrequiredor
  • equivalent requiredand
  • Bachelor's degreein Computer Science, Public Health, Healthcare Informatics, Health Administration, Statistics,preferredor
  • other relevant disciplinepreferred
Experience
  • 3-4 years 4 years of related experience requiredand
  • Experience performing encounter data and enrollment reconciliations in a health plan organization, healthcare claims data, health plan enrollment data, resolving data reconciliation/integrity issues. requiredand
  • Experience working with state medicaid agencies related to enrollment and encounter data errors. requiredand
  • 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 sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.
  • Comprehensive total rewards package - including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.
  • More career opportunities closer to home - as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations.

About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.

MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations. MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws. If you receive an offer of employment, it is MedStar Health's policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.

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