Encounter Data Specialist

Delta Dental Plan of Michigan, Inc.; Okemos (MI); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Comprehensive benefits package

Annual incentive compensation

Paid volunteer time

Job summary

Delta Dental Plan of Michigan, Inc. seeks an Encounter Data Specialist in Okemos, MI (Hybrid). This role focuses on analyzing, correcting, and recommending solutions for encounter data issues while collaborating with stakeholders to ensure compliance.

The ideal candidate needs a Bachelor’s degree and 5 years of experience in health plan benefits administration. A comprehensive benefits package, including medical and dental coverage, is offered.

Qualifications

• 5 years of experience identifying or resolving business issues in health plan administration.
• Preferred: experience with Medicare and/or Medicaid programs.
• Strong knowledge of word processing, spreadsheet, and database applications.

Responsibilities

• Correct rejected encounters in compliance with processing guidelines.
• Research and review encounter data to identify potential issues.
• Monitor and audit encounter submissions to ensure accuracy.

Skills

Strong analytical skills

Strong verbal and written communication skills

Ability to work independently

Experience in health plan benefits administration

Education

Bachelor’s degree in business administration or a related field

Tools

Word processing applications

Spreadsheet applications

Database applications

Job description

Job Title

Encounter Data Specialist

Location

Okemos, MI (Hybrid)

Job Summary

At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy, and community support. The Encounter Data Specialist analyzes, corrects, and recommends solutions to encounter data issues and collaborates with stakeholders to ensure accurate, compliant encounter submissions.

Primary Job Responsibilities

• Correct rejected encounters in compliance with internal and external processing guidelines.
• Research, review, and interpret encounter data to identify potential issues and address rejected records.
• Monitor, manage, and audit encounter submissions to ensure timely and accurate file submission and processing.
• Develop, maintain, and update encounter policies and procedures.
• Partner with functional areas to maintain claims system support tables and perform data entry or maintenance for eligibility, providers, fee sets, and benefits.
• Conduct root cause analysis for encounter errors, review results, processes, and system programming to minimize repeat issues.
• Create and maintain an encounter error library, policies, and procedures for correcting rejected encounters; produce daily and weekly reports.
• Analyze trends of rejected encounters, identify improvement opportunities, and recommend solutions.
• Develop and test internal audit and Integrated Data Management reports to prevent rejections; oversee completion of audit reports in other departments.
• Establish and maintain strong relationships with internal and external plans, partners, and stakeholders to correct, prevent, and resolve encounter errors.
• Serve as a subject matter expert and internal consultant on encounter data, providing training regarding regulatory changes.
• Lead and participate in encounter data and compliance meetings as assigned.
• Oversee compliance with data integrity policies for all system configurations.
• Perform other related assigned duties as necessary.

Minimum Requirements

• Bachelor’s degree in business administration or a related field and five years of experience identifying, analyzing, or resolving business, system, or process issues in health plan benefits administration.
• Preferred: experience in the administration of Medicare and/or Medicaid programs and familiarity with CMS regulations and guidelines.
• Strong knowledge of word processing, spreadsheet, presentation, and database applications.
• Strong verbal and written communication skills; strong analytical skills.
• Ability to work independently and as part of a team; manage multiple assignments with competing deadlines.
• Ability to identify and resolve complex problems using independent judgment.

Benefits

• Comprehensive benefits package including medical, dental, and vision coverage, short- and long-term disability, life insurance, 401(k) savings plans, flexible spending accounts, and tuition reimbursement or educational assistance.
• Annual incentive compensation based on business goals.
• Eight hours of paid volunteer time each year, access to an on‑staff health coach and personal trainer.

Equal Employment Opportunity

The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance. Delta Dental of Michigan, Ohio, and Indiana is an Equal Opportunity Employer.