Encounter Data Specialist

Deltadentalmi; Okemos (MI); On-site; USD 70,000 - 95,000; Full time

Job summary

Delta Dental of Michigan, Ohio, and Indiana is seeking an Encounter Data Specialist in Okemos, MI. This hybrid role focuses on analyzing, correcting, and recommending solutions for encounter data issues while coordinating with internal and external stakeholders.

The specialist will monitor submissions, update policies, and provide data-driven improvements to ensure compliant, accurate data. The ideal candidate has a bachelor’s degree in business administration or related field and at least five

Qualifications

• Bachelor's degree in business administration or related field required.
• Five years of experience identifying, analyzing, or resolving business, system, or process issues in health plan benefits administration preferred.
• Strong communication and analytical skills; ability to manage multiple assignments.

Responsibilities

• Corrects, analyzes, and resolves encounter data issues for internal and external stakeholders.
• Researches and interprets encounter data to identify issues and address rejected records.
• Monitors and audits encounter submissions for timely, accurate file processing.
• Develops and maintains encounter policies and procedures and trains stakeholders on regulatory changes.
• Leads meetings on encounter data and compliance and supports data integrity across systems.

Skills

Analytical skills

Verbal and written communication

Independent worker

Education

Bachelor's degree in business administration or related field

Job description

## Encounter Data SpecialistApplyremote type: This is a hybrid position, both in-office and remote.locations: Okemos, MItime type: Full timeposted on: Posted Yesterdayjob requisition id: JR101388**Job Title:**Encounter Data Specialist**Number of Positions:**1**Location:**Okemos, MI**Location Specifics:**Hybrid Position**Job Summary:**At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation.At Delta Dental, we celebrate our All In culture. It’s a mindset, feeling and attitude we wrap around all that we do – from taking charge of our careers, to helping colleagues and lending a hand in the community.**Position Description:**Analyzes, corrects, and recommends solutions to internal and external stakeholders regarding encounter data issues, policies, processes, requirements, and records.**Primary Job Responsibilities:*** Corrects rejected encounters in compliance with internal and external processing guidelines and best practices.* Researches, reviews, and interprets encounter data to identify potential issues and address rejected records.* Monitors, manages, and audits encounter submissions to ensure timely and accurate file submission and processing.* Develops, maintains, and updates all encounter policies and procedures.* Monitors related processes to ensure internal and external requirements are met, partners with functional areas to maintain claims system support tables, and performs data entry or general data maintenance for eligibility, providers, fee sets, and benefits for related records.* Conducts root cause analysis for encounter errors reviews results, processes, and/or system programming with other departments to minimize repeat issues.* Creates and maintains an encounter error library, policies and procedures to correct rejected encounters, and daily and weekly reports.* Analyzes trends of rejected encounters, identifies opportunities for improvement, and recommends solutions.* Develops and tests internal audit and Integrated Data Management reports to prevent rejections and oversees the completion of audit reports in other departments.* Establishes and maintains strong relationships with internal and external plans, partners, and other stakeholders to correct, prevent, and resolve encounter errors.* Serves as a subject matter expert and internal consultant on encounter data, policies, processes, corrections, and provides training to internal stakeholders regarding regulatory changes.* Leads and participates in encounter data and compliance meetings as assigned.* Oversees compliance with data integrity policies for all system configurations.Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.#LI-Hybrid**Minimum Requirements:**Position requires a 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 the administration of health plan benefits. Previous experience in the administration of Medicare and/or Medicaid programs and Centers for Medicare and Medicaid regulations and guidelines is preferred. Will accept any suitable combination of education, training, or experience. Position requires knowledge of word processing, spreadsheet, presentation, and database applications; strong verbal and written communication skills; strong analytical skills; the ability to work independently and as part of a team; the ability to manage multiple assignments with competing deadlines; and the ability to identify and resolve complex problems using independent judgement.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.