Senior Encounter Data Lead — Compliance & Onboarding

Delta Dental of Michigan; Okemos (MI); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Delta Dental of Michigan, Ohio, and Indiana is seeking a Senior Encounter Data Specialist in Okemos, MI. This hybrid role leads analysis, correction, and implementation activities for encounter data, ensuring compliance with HIPAA, EDI/X12 standards, and internal guidelines.

You will oversee audits, data integrity policies, and cross-functional coordination, mentor staff, and maintain reporting tools to minimize errors and support daily operations of the encounter team.

Qualifications

• Bachelor's degree in business administration or related field.
• Seven years of experience identifying, analyzing, or resolving business, system, or process issues in health plan benefits administration, including encounter data processing.
• Experience with Medicare/Medicaid regulations and guidelines preferred.

Responsibilities

• Represents the encounter team to leadership with reports, progress, metrics, and updates.
• Leads correction of rejected encounters by researching and ensuring compliance with guidelines.
• Monitors, manages, and audits encounter submissions for timely processing.
• Oversees onboarding activities for new customers, coordinating cross-functional efforts.
• Serves as SME during audits, prepares documentation and responds to audit requests.
• Oversees EDI and X12 data exchange compliance and HIPAA requirements.
• Maintains encounter policies, error libraries, and reporting tools.
• Leads data-related process improvements and cross-functional collaboration to meet requirements.
• Drives recruitment and training of new encounter data staff.

Skills

EDI formats

Encounter data

Analytics

Cross-functional leadership

Audit coordination

Data integrity

HIPAA compliance

Report generation

Microsoft Office

Education

Bachelor's degree in business administration

Tools

Microsoft Excel

EDI tooling

Job description

Delta Dental of Michigan, Ohio, and Indiana is seeking a Senior Encounter Data Specialist in Okemos, MI. This hybrid role leads analysis, correction, and implementation activities for encounter data, ensuring compliance with HIPAA, EDI/X12 standards, and internal guidelines.

You will oversee audits, data integrity policies, and cross-functional coordination, mentor staff, and maintain reporting tools to minimize errors and support daily operations of the encounter team.