Healthcare Claims Payer data - Data Steward - Data Governance

Top 3 Skills:

• Deep understanding of Healthcare Payer Claims Transactions and Business Operations 5+ years of healthcare payer claims experience
• Previous and deep interaction with healthcare Payer Claims Business Stakeholders
• 5+ years of Data Stewardship, enforcing operational Data Governance data policies, standards, and rules in real-time, across different data systems and sources. (Have dealt with handling variety, velocity, and volume of data via a flexible, dynamic, and scalable approach.

Role Summary
The Claims Transaction Data, Data Steward is a member of a cross-functional Data Governance team who partners with business, technical, and regulatory partners to ensure the documentation and implementation of Claims Transactions data standards. The Data Steward leads complex, cross-organizational conversations including risk assessment, data quality auditing, issue management, and knowledge management to ensure Claims Transaction data is fit for organization use. Candidates should have a strong data management background understanding how data is organized and relationships maintained between data domains across multiple enterprise system with a strong drive towards improving data quality and governance.
Responsibilities

• Serves as Data Steward as part of an Agile team dedicated to Claims Transaction data operations & initiatives.
• Leads Data Governance collaborations with Payer stakeholders to document, define, maintain, and manage Claims Transaction data standards and assets.
• Assesses and monitors data quality metrics, analyzing trends and proactively promoting remediation and preventive action efforts.
• Partners with IT and business teams to ensure the use of best practices and compliance with data standards.
• Provides consultative stewardship services to delivery and issue resolution teams, serving as subject matter expert as needed.
• Provides guidance on development, usage, and inventory of technical assets.
• Represents GBS Data Governance in enterprise workgroups and data steward communities of practice.

Qualifications

• Bachelor s degree or higher
• 5+ years professional work experience in:
  • Data Stewardship, Data Governance, Data Management and Data Quality practices
  • Healthcare Payer Claims Transactions and Revenue Cycle operations
  • Claims Transaction data standards and operations, including:
    • Patient check-in and registration
    • Eligibility verification
    • Medical coding ICD-10, CPT, HCPCS, SNOMED CT - ASC X12N Implementation Guides
    • Claim submission
    • Claim processing
    • Claim payment
    • Claim reconciliation
    • Coordination of Benefits
• Strong communications skills; written, verbal and presentation
• Self-driven and able to function with minimal direction
• Has the ability to engage business and data stakeholders to resolve questions or issues
• Must have the ability to handle multiple and sometimes competing priorities in a fast-paced environment
• Must be able to think creatively, innovate and flex where needed - quick/adaptive learner and collaborator/team player
• Must have strong analytical and problem-solving capabilities
• Able to strategize across complex, cross-functional projects and initiatives
• Experience in Agile Methodology and tools (e.g., Jira, Rally, etc.)
• Intermediate to Advanced data analysis skills and tools (e.g., SQL, SAS, Python, Hadoop, Teradata, Snowflake, Tableau, Collibra, Infosphere, Alation, etc.)