Enrollment & Encounter Data Specialist

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

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.