MedStar Research Institute, Inc.
Enroll/Encounter Data Steward
MedStar Research Institute, Inc., Washington, District of Columbia, us, 20022
Overview:
The Enrollment/Encounter Data Steward is responsible for managing the reconciliation and integrity of enrollment and encounter data to ensure accurate and timely submission to delegated vendors. The steward collaborates with a Business Process as a Service (BPaaS) vendor to monitor, analyze, and resolve encounter data rejections, ensuring corrected data is resubmitted in accordance with CMS and/or state regulatory requirements. The role tracks and reports on encounter submission trends, reconciles membership and enrollment data across internal systems and delegated entities, and supports monthly and ad‑hoc reconciliation cycles with internal stakeholders and external vendors. Strong operational knowledge and hands‑on EDI experience (834, 837I, 837P, NCPDP) are essential, along with a proactive mindset for data accuracy and regulatory compliance.
Primary Duties and Responsibilities
Serve as the primary point of contact with MDH/DHCF on encounter data issues; report, track, and resolve enrollment discrepancies to regulatory partners.
Complete complex root‑cause analysis and research of encounter errors; partner with the BPaaS vendor to generate corrections and facilitate timely resubmission.
Access and analyze data using Tableau, MS Excel, and SQL to monitor and create monthly, quarterly, and ad‑hoc reports for management.
Collaborate with departments and vendors to identify missing data or anomalies, and work with them to correct encounter data errors while providing guidance on regulatory reporting requirements.
Reconcile enrollment and encounter data within the EDW (Enterprise Data Warehouse) and confirm accuracy with delegated vendors.
Identify trends and variances in encounter data, research findings, and determine the appropriate level of escalation to leadership.
Develop and maintain relationships with impacted business areas and external partners to support interoperability compliance.
Perform special projects as needed.
Education
Bachelor’s degree in Computer Science, Public Health, Healthcare Informatics, Health Administration, Statistics, or another relevant discipline.
One year of relevant education may be substituted for one year of required work experience.
Experience
3–4 years of related experience in encounter data and enrollment reconciliations within a health‑plan organization.
Experience working with state Medicaid agencies related to enrollment and encounter data errors.
One year of relevant professional‑level work experience may be substituted for one year of required education.
Knowledge, Skills, and Abilities
Knowledge of encounter data processes (837I, 837P, NCPDP files).
Advanced proficiency in MS Excel and enterprise database programs (e.g., SQL).
Strong understanding of operational activities around claims processing and benefit configuration.
Familiarity with a data warehouse environment.
Knowledge of medical terminology and experience 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.
Salary Range $70,428 – $131,310 per year (salary based on skills and experience).
Additional Information
Seniority Level: Mid‑Senior
Employment Type: Full‑time
Job Function: Other
Location: Washington, DC (eligible applicants can also be on the West and East Coast; referral process encourages internal candidate placement)
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The Enrollment/Encounter Data Steward is responsible for managing the reconciliation and integrity of enrollment and encounter data to ensure accurate and timely submission to delegated vendors. The steward collaborates with a Business Process as a Service (BPaaS) vendor to monitor, analyze, and resolve encounter data rejections, ensuring corrected data is resubmitted in accordance with CMS and/or state regulatory requirements. The role tracks and reports on encounter submission trends, reconciles membership and enrollment data across internal systems and delegated entities, and supports monthly and ad‑hoc reconciliation cycles with internal stakeholders and external vendors. Strong operational knowledge and hands‑on EDI experience (834, 837I, 837P, NCPDP) are essential, along with a proactive mindset for data accuracy and regulatory compliance.
Primary Duties and Responsibilities
Serve as the primary point of contact with MDH/DHCF on encounter data issues; report, track, and resolve enrollment discrepancies to regulatory partners.
Complete complex root‑cause analysis and research of encounter errors; partner with the BPaaS vendor to generate corrections and facilitate timely resubmission.
Access and analyze data using Tableau, MS Excel, and SQL to monitor and create monthly, quarterly, and ad‑hoc reports for management.
Collaborate with departments and vendors to identify missing data or anomalies, and work with them to correct encounter data errors while providing guidance on regulatory reporting requirements.
Reconcile enrollment and encounter data within the EDW (Enterprise Data Warehouse) and confirm accuracy with delegated vendors.
Identify trends and variances in encounter data, research findings, and determine the appropriate level of escalation to leadership.
Develop and maintain relationships with impacted business areas and external partners to support interoperability compliance.
Perform special projects as needed.
Education
Bachelor’s degree in Computer Science, Public Health, Healthcare Informatics, Health Administration, Statistics, or another relevant discipline.
One year of relevant education may be substituted for one year of required work experience.
Experience
3–4 years of related experience in encounter data and enrollment reconciliations within a health‑plan organization.
Experience working with state Medicaid agencies related to enrollment and encounter data errors.
One year of relevant professional‑level work experience may be substituted for one year of required education.
Knowledge, Skills, and Abilities
Knowledge of encounter data processes (837I, 837P, NCPDP files).
Advanced proficiency in MS Excel and enterprise database programs (e.g., SQL).
Strong understanding of operational activities around claims processing and benefit configuration.
Familiarity with a data warehouse environment.
Knowledge of medical terminology and experience 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.
Salary Range $70,428 – $131,310 per year (salary based on skills and experience).
Additional Information
Seniority Level: Mid‑Senior
Employment Type: Full‑time
Job Function: Other
Location: Washington, DC (eligible applicants can also be on the West and East Coast; referral process encourages internal candidate placement)
#J-18808-Ljbffr