Medicare Provider Data Quality & Accuracy-Credentialing Data Steward

Summary 

The Credentialing Data Steward is an Advisor level role within the Provider Data Quality & Accuracy team, responsible for maintaining data lineage, business rules around data elements and documentation and usage of each element. 

The team will work with multiple stakeholders across future state Medicare operations, as defined by the Dedicated Medicare Operating Model (DMOM) project.  They will help to drive improvements in the provider data domain to ensure we meet specific goals and metrics, as defined by business and regulatory requirements. 

Essential Functions and Responsibilities 

• Coordinate and partner with the key Medicare operations teams, including claims, enrollment, fulfillment, network operations, and technology, to ensure delivery of operational excellence. 

• Monitoring of provider data accuracy leading to CMS compliant provider directories as well as assisting with improved claims auto-adjudication. 

• Work within the Data Quality management process to champion incremental improvements and deployments that result in measurable improvements in data quality, understanding the business impacts and prioritizing the data quality remediation. 

• Support the development of and oversee quality metrics and monitoring processes to ensure data integrity and accuracy.  Implement data cleansing and validation procedures. 

• Identify and mitigate data-related risks.  Implement and monitor controls to safeguard data assets and ensure their proper usage. 

• Track KPIs to measure the effectiveness of data governance initiatives.  Provide regular reports to senior management on data governance activities and progress. 

Qualifications 

Candidates should model our team’s core values – Communicate Effectively and Instills Trust.  They should also have the following skillset and characteristics. 

Preferred Qualifications: 

• Bachelor’s degree 

• At least 5 years of relevant experience, i.e. data governance, data management. 

• The ideal candidate will have experience building their own SQL (Teradata preferred) queries, or willing to learn SQL in the first 6 months. 

• Proficiency in data governance tools and technologies is a plus. 

• Certification in data management (e.g. CDMP, DGSP) is a plus. 

• Preference given to a candidate with experience in working with credentialing data/operations.

• Strong analytical, synthesizing, & problem-solving skills with emphasis on utilizing business processes & technology to solve business problems.   

• Demonstrated ability to work at both conceptual & detailed levels. 

• Willingness to share opinions and take risks.  

• Experience with client facing business units preferred. 

• Creative thinker with ability to think outside the box & translate strategies into actions.   

• Must possess strong organizational skills with ability to manage multiple priorities simultaneously. 

• Strong, clear, concise, and analytical written and oral communication skills.