Enroll/Encounter Data Steward Job Listing at MedStar Health in Washington, DC (Job ID 100464)

Description

General Summary of Position
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. Collaborates 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.

Primary Duties and Responsibilities

• Bachelor's degree in Computer Science Public Health Healthcare Informatics Health Administration Statistics or other relevant discipline required
• One year of relevant education may be substituted for one year of required work 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
• One year of relevant professional-level work experience may be substituted for one year of required education.

• Knowledge of encounter data processes 837I 837P and NCPDP files etc.
• Advanced proficiency in personal computer programs including MS Excel required and enterprise database programs (e.g. SQL).
• Strong understanding of operational activities around claims claims processing benefit configuration.
• 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.