Hybrid Encounter Data Analyst

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

Job summary

Delta Dental of Michigan, Ohio, and Indiana seeks an Encounter Data Specialist to manage and improve encounter data operations. You will identify, analyze, and resolve rejected records and collaborate with stakeholders to strengthen data quality and submission outcomes.

The role focuses on compliance with HIPAA and state/federal requirements, with a hybrid work arrangement in Okemos, MI, and opportunities to influence policy and process improvements.

Qualifications

• Bachelor's degree in business administration or related field required.
• Five years' experience identifying, analyzing, or resolving business, system, or process issues in health plan benefits.
• Experience with encounter data processing preferred; CMS regulations knowledge a plus.

Responsibilities

• Researches, analyzes, corrects, and resubmits rejected encounter records per guidelines and SLAs.
• Reviews, interprets, monitors, and audits encounter data for compliance and timely processing.
• Develops and updates encounter policies, procedures, and error libraries.
• Monitors processes and system configuration for compliance and data integrity.
• Supports new customer implementation by coordinating encounter activities and timelines.
• Supports audits by gathering information and coordinating documentation.
• Reviews EDI/X12 exchanges to ensure HIPAA and partner guidelines compliance.
• Identifies issues and root causes; collaborates on corrective actions to reduce rejections.
• Presents recurring metrics to clients and stakeholders in understandable terms.

Skills

Verbal and written communication

Analytical skills

Multitasking

Independent and collaborative work

Education

Bachelor's degree in business administration or related field

Tools

SQL

EDI formats

Database applications

Microsoft Office

Job description

Delta Dental of Michigan, Ohio, and Indiana seeks an Encounter Data Specialist to manage and improve encounter data operations. You will identify, analyze, and resolve rejected records and collaborate with stakeholders to strengthen data quality and submission outcomes.

The role focuses on compliance with HIPAA and state/federal requirements, with a hybrid work arrangement in Okemos, MI, and opportunities to influence policy and process improvements.