Senior Encounter Data Lead — Hybrid

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

Job summary

Delta Dental Plan of Michigan, Inc. in Okemos, MI is seeking a Senior Encounter Data Specialist to lead analysis, correction, and recommendations on encounter data issues. The role will ensure compliance with internal guidelines and external processing standards.

You will oversee audits, EDI/X12 exchanges, data integrity, and cross‑functional onboarding activities, while maintaining strong stakeholder relationships and adherence to HIPAA requirements.

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 HIPAA guidance is preferred.

Responsibilities

• Represents the encounter team to leadership with reports, project progress, metrics, and updates.
• Leads correction of rejected encounters by researching and ensuring compliance with guidelines.
• Monitors and audits encounter submissions for timely and accurate processing.
• Leads onboarding activities for new customers and cross-functional coordination.
• Serves as SME during audits and coordinates materials and responses.
• Oversees EDI and X12 data exchange compliance with HIPAA and partner mandates.
• Manages policies, error libraries, and reporting tools for daily/weekly oversight.
• Coordinates data maintenance for eligibility, providers, and benefits records.
• Performs root cause analysis to prevent recurrence of issues.
• Builds relationships with internal/external plans and stakeholders.

Skills

EDI formats

Data analysis

Cross-functional leadership

Auditing

Regulatory compliance

Communication skills

Microsoft Office

Education

Bachelor's degree in business administration or related field

Tools

Microsoft Excel

ERP/healthplan systems

Job description

Delta Dental Plan of Michigan, Inc. in Okemos, MI is seeking a Senior Encounter Data Specialist to lead analysis, correction, and recommendations on encounter data issues. The role will ensure compliance with internal guidelines and external processing standards.

You will oversee audits, EDI/X12 exchanges, data integrity, and cross‑functional onboarding activities, while maintaining strong stakeholder relationships and adherence to HIPAA requirements.