Encounter Data Analyst - Hybrid, Compliance & QA

Delta Dental of Michigan; Okemos (MI); Hybrid; USD 70,000 - 90,000; Full time

Benefits offered by this job

Hybrid work

Job summary

Delta Dental of Michigan, Ohio, and Indiana seeks an Encounter Data Specialist to ensure accurate and compliant encounter data operations. You will identify, analyze, and resolve rejected records and improve related policies and processes, collaborating with internal and external stakeholders to strengthen data quality.

The role supports audits, data integrity, and new customer implementations, with a hybrid work arrangement in Okemos, MI.

Qualifications

• Bachelor’s degree required and five years of related experience in health plan data or process improvement.
• Experience with encounter data processing and CMS/MediCare/Medicaid guidance preferred.
• Knowledge of EDI formats, SQL, databases, reporting tools, and MS Office.

Responsibilities

• Research, analyze, correct, and resubmit rejected encounter records per guidelines.
• Audit and monitor encounter data and file submissions for timeliness and accuracy.
• Develop and update encounter policies, procedures, and error guidance.
• Maintain system configuration and data integrity across claims systems.
• Coordinate encounter activities for new customer implementations.
• Support audits by gathering info and coordinating with departments.
• Review EDI/X12 exchanges to ensure HIPAA and partner guidelines compliance.
• Identify rejection trends and propose root-cause fixes and process improvements.
• Prepare recurring metric reports for clients and stakeholders.

Skills

EDI formats

SQL

Database applications

Analytical reporting tools

Microsoft Office

Education

Bachelor's degree in business administration or related field

Job description

Delta Dental of Michigan, Ohio, and Indiana seeks an Encounter Data Specialist to ensure accurate and compliant encounter data operations. You will identify, analyze, and resolve rejected records and improve related policies and processes, collaborating with internal and external stakeholders to strengthen data quality.

The role supports audits, data integrity, and new customer implementations, with a hybrid work arrangement in Okemos, MI.