Medicaid Encounter Data Analyst (Remote Position in WI)

Network Health; Menasha (WI); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Network Health in Wisconsin seeks an Encounter Data Analyst to support Medicaid encounter data functions and ensure compliance with DHS regulations. You will identify data errors, coordinate corrections with vendors and internal teams, and help maintain the METS tool.

This role requires experience with Medicaid, DHS submissions (837/834), and data-driven process improvements. The position emphasizes collaboration with claims, enrollment, IT, and other departments, plus attendance at DHS calls

Qualifications

• 3+ years in a health insurance or government programs role
• 2+ years as a Business Analyst or similar role
• Prior Medicaid experience with DHS file submissions (837/834)
• Experience using data to identify trends, solve problems and improve processes
• Ability to analyze data to determine error sources and trends
• Intermediate/advanced Microsoft Office skills; SQL preferred

Responsibilities

• Lead the encounter data error identification effort and coordinate error resolutions with external vendors and clients as well as internal departments
• Act as a liaison between external vendors, clients and internal departments
• Coordinate the maintenance and enhancements for the Medicaid Encounter Tracking System (METS) tool
• Develop workflows and other documentation related to encounter data processes
• Remain informed and updated on industry changes e.g. DHS regulations and changes and how they impact encounter data submissions
• Attend all DHS technical calls
• Propose innovative approaches to create or improve automation and optimize processes

Skills

Data analysis

Problem solving

Communication

Attention to detail

Querying

Education

Bachelor's Degree in Information Technology or Health Care Information

Tools

SQL

Microsoft Office

Reporting tools

Job description

Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities. Network Health is seeking an Encounter Data Analyst to support the critical encounter data functions for our Medicaid TPA line of business.

This position is responsible for the identification and correction of data errors as well as coordinating error corrections with internal departments and external vendors & clients. Additionally, this role maintains compliance with all Department of Health Services (DHS) laws, guidance, regulations and standards.

Location:

Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate offices in Menasha or Brookfield will be required occasionally for the position, including on first day.

Hours:

1.0 FTE, 40 hours per week, 8am-5pm Monday through Friday

Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities:

• Lead the encounter data error identification effort and coordinate error resolutions with the external vendors and clients as well as key internal departments (i.e. claims, enrollment, provider, IT etc.)
• Act as a liaison between external vendors, clients and internal departments
• Coordinate the maintenance and enhancements for the Medicaid Encounter Tracking System (METS) tool.
• Develop workflows and other documentation related to encounter data processes
• Remain informed and updated on industry changes e.g. DHS regulations and changes and how they impact encounter data submissions
• Attend all DHS technical calls
• Propose innovative approaches to create or improve automation and optimize processes.

Job Requirements:

• Bachelor's Degree in Information Technology, Health Care Information or similar field required, or equivalent years of experience may be substituted.
• 3+ years working in a health insurance or government programs role required.
• 2+ years' experience working as a Business Analyst or similar role required.
• Prior experience with Medicaid required. This includes working with DHS file submissions, 837 and 834 file submissions and health plan data including provider and claims processing systems.
• Experience using data to identify trends, solve problems and improve processes.
• Must be able to analyze data to determine error sources and trends
• Understanding of database management, system design, querying and report-writing tools.
• Intermediate/advanced skills working with Microsoft Office Suite.
• SQL skills preferred

Network Health is an Equal Opportunity Employer.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.