Encounter Data Quality & Compliance Analyst

Delta-Dental; Okemos (MI); Hybrid; USD 70,000 - 100,000; Full time

Job summary

Delta Dental of Michigan, Ohio, and Indiana seeks an Encounter Data Specialist to support accurate, compliant data submissions across HIPAA and state guidelines. You will identify rejected records, analyze root causes, and collaborate with internal teams to strengthen data quality and timely processing.

Responsibilities include reviewing EDI/X12 exchanges, auditing data submissions, maintaining correction policies, and preparing client reports.

Qualifications

• Bachelor's degree in business administration or related field.
• Five years of experience identifying, analyzing, or resolving business, system, or process issues in health plan benefits.
• Experience with encounter data processing preferred.
• Experience administering Medicare and/or Medicaid programs and CMS regulations preferred.

Responsibilities

• Researches, analyzes, corrects, and resubmits rejected encounter records per guidelines.
• Reviews, interprets, monitors, and audits encounter data and submissions for compliance.
• Develops and updates encounter policies, procedures, and error libraries.
• Monitors processes and updates system data for accuracy and integrity.
• Supports audits by providing information and coordinating documentation.
• Prepares recurring metric reports for clients and stakeholders.

Skills

EDI formats

SQL

Analytical reporting

Microsoft Office

Verbal & written communication

Time management

Education

Bachelor's degree in business administration

Tools

Encounter data processing

Job description

Delta Dental of Michigan, Ohio, and Indiana seeks an Encounter Data Specialist to support accurate, compliant data submissions across HIPAA and state guidelines. You will identify rejected records, analyze root causes, and collaborate with internal teams to strengthen data quality and timely processing.

Responsibilities include reviewing EDI/X12 exchanges, auditing data submissions, maintaining correction policies, and preparing client reports.