Encounter Data Specialist

Delta Dental Plan of Michigan, Inc.; Okemos (MI); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

401(k) savings plans

Annual incentive compensation

Job summary

Delta Dental of Michigan, Ohio, and Indiana seeks an Encounter Data Specialist to support accurate and compliant encounter data operations. Hybrid position based in Okemos, MI.

You will analyze rejected records, ensure data integrity, and coordinate with multiple internal and external stakeholders to strengthen submission outcomes. The role emphasizes policy development, audits, and reporting, with responsibilities spanning data monitoring, file submissions, and system updates.

Qualifications

• Bachelor's degree in business administration or related field is required.
• Five years of experience identifying, analyzing, or resolving business, system, or process issues in health plan benefits administration is required.
• Knowledge of EDI formats, SQL, database applications, analytical reporting tools, and MS Office is required.
• Strong verbal and written communication skills; ability to manage multiple tasks with deadlines; ability to work independently and collaboratively.

Responsibilities

• Researches, analyzes, corrects, and resubmits rejected encounter records per guidelines and SLAs.
• Reviews and audits encounter data and file submissions for accuracy and compliance.
• Develops and maintains encounter policies, procedures, and error libraries.
• Monitors data integrity and updates related system tables and benefit information.
• Supports new customer implementations and tracks related tasks.
• Assists audits by providing required information and coordinating with departments.
• Reviews EDI/X12 data exchanges to ensure HIPAA compliance and industry standards.
• Identifies error trends and recommends corrective actions and process improvements.
• Prepares recurring metric reports for clients and internal stakeholders.
• Performs other duties as needed to support primary responsibilities.

Skills

Analytical skills

Verbal and written communication

Independent judgment

Multitasking

Team collaboration

Education

Bachelor's degree in business administration or related field

Tools

SQL

EDI formats

Analytical reporting tools

Database applications

Microsoft Office

Job description

Job Title: Encounter Data Specialist

Location: Okemos, MI; Position: Hybrid; 1 Position available.

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 is 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

Supports accurate and compliant encounter data operations by identifying, analyzing, and resolving rejected records and other encounter data issues; improving related policies, processes, requirements, and records; and collaborating with internal and external stakeholders to strengthen data quality and submission outcomes.

Primary Job Responsibilities

• Researches, analyzes, corrects, and resubmits rejected encounter records in accordance with internal and external guidelines, contractual service level agreements, and applicable state and federal requirements.
• Reviews, interprets, monitors, and audits encounter data and file submissions to identify issues, validate accurate and timely processing, and ensure compliance with applicable requirements.
• Develops, maintains, and updates encounter policies, procedures, rejection correction guidance, error libraries, and routine operational reports.
• Monitors encounter processes and system configuration for compliance with internal and external requirements and data integrity policies; collaborates with functional areas to maintain claims system support tables; and updates eligibility, providers, fee sets, and benefit information for related records.
• Supports new customer implementation by coordinating encounter-related activities, tracking assigned tasks, and helping ensure requirements are met in alignment with internal processes and external expectations.
• Supports internal and external audits by gathering requested information, completing assigned audit documentation, providing supporting materials, communicating findings or updates, and coordinating completion of audit reports with other departments.
• Reviews electronic data interchange (EDI) and X12 data exchanges to help ensure compliance with applicable industry standards, HIPAA requirements, and partner-specific encounter data guidelines.
• Identifies configuration issues, encounter error and rejection trends, and file failures; conducts root cause analysis and collaborates with internal departments to recommend, develop, and test corrective actions, audit reports, and processes improvements that strengthen data integrity and reduce recurring rejections.
• Prepares and presents recurring metric reports to clients and other stakeholders, translating technical findings to non-technical audiences.
• 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.
• Experience with encounter data processing is preferred.
• Experience administering Medicare and/or Medicaid programs and applying Centers for Medicare and Medicaid Services regulations and guidelines is also preferred.
• Will accept any suitable combination of education, training, or experience.
• Position requires knowledge of EDI formats, SQL, database applications, analytical reporting tools, and Microsoft Office applications; strong verbal and written communication skills; strong analytical skills; ability to manage multiple assignments with competing deadlines; ability to work independently and collaboratively; and the ability to identify and resolve complex problems using independent judgment.

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.

About Delta Dental of Michigan, Ohio, and Indiana

Delta Dental of Michigan, Ohio, and Indiana has been a dental benefits leader for more than 60 years, and today with our affiliates, we are one of the largest dental plan administrators in the country. It's our mission to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by making investments that build healthy, smart, vibrant communities. We celebrate diverse thought and foster a culture where employees go All In - for the company, themselves, their colleagues and their communities.

Benefits

• Medical, dental and vision coverage
• Short- and long-term disability
• Life insurance
• 401(k) savings plans
• Flexible spending accounts
• Tuition reimbursement or educational assistance
• Annual incentive compensation based on annual business goals
• Eight hours of paid volunteer time each year
• Access to an on-staff health coach and personal trainer
• Many other perks

Delta Dental is an Equal Opportunity Employer.