Enrollment Encounter Data Analyst

Upper Peninsula Health Plan (UPHP); Marquette (MI); On-site; USD 28,000 - 33,000; Full time

Job summary

Upper Peninsula Health Plan (UPHP) is seeking an Enrollment/Encounter Data Analyst to compile, analyze, trend, track, and interpret Medicare-Medicaid enrollment activities. The role involves researching and resolving pended and rejected Medicaid and Medicare encounters per contract guidelines.

The position supports data integrity across enrollment, encounter processing, and newborn activities, coordinating with the CHAMPS system and MDHHS, and ensuring timely resolutions.

Qualifications

• Associate degree or equivalent with relevant experience; may consider five years of experience in lieu of degree.
• Bachelor’s degree preferred in health information management or related field.
• Two to four years of claims management, information systems, accounting, or related experience.

Responsibilities

• Follows UPHP policies and procedures and maintains confidentiality.
• Ensures data integrity in enrollment and encounter processes and analyzes 834/837 transactions.
• Liaises with MDHHS for 834 audit and file reconciliations.
• Oversees submission of CHAMPS issues and resolves enrollment/encounter discrepancies.
• Resolves inquiries regarding enrollment, encounter, and newborn activities from staff, providers, and members.
• Verifies Maternity Case Rate payments and newborn enrollment status.
• Acts as CHAMPS Domain Administrator and processes member ID cards.
• Tests 834 enrollment file changes with Data Infrastructure team.
• Coordinates with vendors and internal staff on data submissions.
• Supports audits and compliance reviews with data SMEs.
• Contributes to Revenue Reconciliation and capitation payments resolution.
• Collaborates with Compliance on Program Integrity submissions.

Skills

Keyboarding proficiency

Excellent communication

Excellent organizational abilities

Medical terminology

Independent work

Managed care awareness

Education

Associate degree in health information processing or related field

Bachelor’s degree in health information management or related field

Tools

Microsoft Word

Microsoft Excel

Microsoft Access

PowerPoint

Job description

DATE: September 28, 2026

POSITION: Enrollment/Encounter Data Analyst

DEPARTMENT: Finance/Claims

RATE: $22.00 per hour, with potential for additional compensation based on qualifications.

POSITION SUMMARY:

This position is responsible for compiling, analyzing, trending, tracking, and interpreting all Medicare-Medicaid Plan and Medicaid enrollment activities and is responsible for researching, interpreting, analyzing, and correcting all pended and rejected Medicaid and Medicare encounters including complex encounter issues in accordance with contract guidelines.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Follows established UPHP policies and procedures, objectives, safety standards, and sensitivity to confidential information.

2. Ensures data integrity and accuracy in all enrollment and encounter processes through analysis of potential system issues with the 834 and 837 transactions. Serves as the subject matter expert and liaison for 834 audit and daily file reconciliations with the Michigan Department of Health & Human Services (MDHHS); participates in the enrollment and encounter workgroup meetings as necessary.

3. Submits Medicaid service requests through the Community Health Automated Medicaid Processing System (CHAMPS) to MDHHS regarding enrollment and/or payment issue discrepancies as well as MI Health Link (MHL) discrepancies and immediate access of care issues between the Center for Medicare and Medicaid Services (CMS) and MDHHS.

4. Oversees and works closely with the encounter vendor and internal staff to ensure the accurate and timely submissions of encounter data and analyzes and resolves encounter pends/rejects in the encounter system.

5. Responsible for the day-to-day resolution of verbal and written inquiries regarding enrollment, encounter, and newborn activities from other staff, providers, and members, and works closely with claims staff assessing and confirming that all incoming enrollment, provider, and claims data is accurate and complete.

6. Verifies Maternity Case Rate (MCR) payments have been received for all qualifying births and that newborns are enrolled with UPHP appropriately.

7. Serves as Domain Administrator for CHAMPS.

8. Processes member ID cards and new member packets. Validates health plan material mailings by the print vendor, verifies vendor invoices, and ensures print vendor compliance with our contract.

9. Works closely with the Data Infrastructure (DI) team to test and validate 834 enrollment file and 837 encounter file change to accommodate MDHHS and/or CMS requirements.

10. Acts as liaison to external vendors regarding enrollment and encounter data when outreach is needed.

11. Serves as enrollment and encounter data subject matter expert for audits and compliance reviews.

12. Works with the Risk Adjustment Analyst & Coding Compliance Auditor to interpret and correct errors within the risk adjustment and encounter data processing systems.

13. Participates in the Revenue Reconciliation process including assisting the Finance Department with identifying and resolving capitation rate payment issues.

14. Works closely with the Compliance Department and external vendors to identify and validate accurate claim encounter activity for Program Integrity submissions to MDHHS.

15. Maintains written documentation of all activities and revises procedures and policies to increase efficiency and accommodate any changes.

16. Applies for Wisconsin Medicaid on behalf of TPA Client, WI Department of Corrections, incarcerated individuals, while they are inpatient status.

17. Maintains confidentiality of client data.

18. Performs other related duties as assigned or requested.

POSITION QUALIFICATIONS:

Education:

Minimum:

Associate degree in health information processing, computer information systems, accounting,

business, or related field; five (5) years of relevant experience in lieu of a degree will be

considered

Preferred:

Bachelor’s degree in health information management, computer information systems,

accounting, or related field

Experience:

Minimum:

Two (2) to four (4) years of claims management, information systems, accounting, or relevant

experience

Preferred:

Four (4) to six (6) years of experience reporting, analyzing, interpreting and presenting data;

experience analyzing large data files and performing file reconciliations; knowledge of CPT,

HCPCS, ICD-10 coding; revenue codes; DRG, UB-04 and CMS-1500 claims submission and

electronic claims submissions; APC reimbursement methodology: and MSA and CMS policy

Required Skills:

Keyboarding proficiency and working knowledge of MS Office (Word, Excel, Access, and Power Point)

Excellent human relation and oral/written communication

Excellent organizational abilities with attention to detail

Medical terminology

Ability to work independently and to prioritize tasks with minimal supervision

Preferred Skills:

Oriented to managed care and health care systems

The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.

Physical Requirements:

[This job requires the ability to perform the essential functions contained in the description. These include, but are not limited to, the following requirements. Reasonable accommodations may be made for otherwise qualified applicants unable to fulfill one or more of these requirements]:

Ability to enter and access information from a computer

Ability to access all areas of the UPHP offices

Occasionally lifts supplies/equipment

Prolonged periods of sitting

Manual dexterity

Working Conditions:

Works in office conditions

Exposure to clients and others who may require exceptional interpersonal skills

Subject to many interruptions

Occasional travel may be required