Senior Encounter Data Specialist

Delta Dental Plan of Michigan, Inc.; Okemos (MI); Hybrid; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

401(k) savings plans

Tuition reimbursement

Paid volunteer time

Access to health coach and personal trainer

Job summary

Delta Dental Plan of Michigan, Inc. is seeking a Senior Encounter Data Specialist in Okemos, MI (Hybrid) to enhance oral health through effective benefit plans and community support. The role involves addressing encounter data issues, presenting to leadership, conducting audits, and managing compliance with health plan regulations.

Ideal candidates have a bachelor’s degree and 7 years in health plan benefits administration. Comprehensive benefits include medical, dental, vision, and tuition reimbursement, among others.

Qualifications

• 7 years experience resolving business, system, or process issues in health plan benefits.
• Experience in administration of Medicare/Medicaid programs preferred.
• Strong interpersonal skills and ability to represent to leadership.

Responsibilities

• Leads organization, analysis, correction and recommendation of encounter data solutions.
• Conducts trend analysis of rejected encounters and develops improvement reports.
• Establishes relationships with stakeholders to resolve encounter errors.

Skills

Verbal and written communication skills

Analytical skills

Team leadership

Problem-solving

Interpersonal skills

Education

Bachelor's degree in business administration or related field

Tools

Word processing applications

Spreadsheet applications

Presentation applications

Database applications

Job description

Job Title:

Senior Encounter Data Specialist

Number of Positions:

1

Location:

Okemos, MI (Hybrid)

Job Summary:

At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation. At Delta Dental, we celebrate our All In culture. It’s a mindset, feeling and attitude we wrap around all that we do – from taking charge of our careers, to helping colleagues and lending a hand in the community.

Position Description:

Leads the organization, analysis, correction and recommendation of solutions to internal and external stakeholders regarding encounter data issues, policies, processes, requirements, and records.

Primary Job Responsibilities:

• Represents encounter team to leadership, presenting reports, project progress, metrics and other deliverables.
• Leads the correction of rejected encounters in compliance with internal and external processing guidelines and best practices.
• Oversees the team’s efforts in researching, reviewing, and interpretation of encounter data to identify potential issues and address rejected records.
• Monitors, manages, and audits encounter submissions to ensure timely and accurate file submission and processing.
• Monitors the development, implementation and maintenance of encounter policies and procedures.
• Monitors and evaluates related processes to ensure internal and external requirements are met, represents the encounter team when partnering with functional areas to maintain claims system support tables, and coordinates data entry or general data maintenance for eligibility, providers, fee sets, and benefits for related records.
• Oversees the root cause analysis for encounter errors and reviews results, processes, and/or system programming with other departments to minimize repeat issues.
• Oversees the development and maintenance of the encounter error library, policies and procedures to correct rejected encounters, and daily and weekly reports.
• Conducts trend analysis of rejected encounters and develops reports to identify opportunities for improvement, and recommends solutions.
• Monitors the development and testing of internal audit and Integrated Data Management reports to prevent rejections and oversees the completion of audit reports in other departments.
• Establishes and maintains strong relationships with internal and external plans, partners, and other stakeholders to correct, prevent, and resolve encounter errors.
• Serves as lead subject matter expert and key internal consultant on encounter data, policies, processes, corrections, and develops training for internal stakeholders regarding regulatory changes.
• Coordinates and leads encounter data and compliance meetings.
• Oversees compliance with data integrity policies for all system configurations.
• Leads the recruitment process for new encounter data staff, including interviewing, selection, onboarding and training.
• Assures adherence to company policies and internal controls, regulatory compliance, and general principles.
• Communicates and manages encounter deliverables to ensure compliance with state requirements and contract SLAs.
• Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

Minimum Requirements:

• Position requires a bachelor’s degree in business administration or a related field and seven years of experience identifying, analyzing, or resolving business, system, or process issues in the administration of health plan benefits.
• Previous experience in the administration of Medicare and/or Medicaid programs and Centers for Medicare and Medicaid regulations and guidelines is preferred.
• Will accept any suitable combination of education, training, or experience.
• Position requires knowledge of word processing, spreadsheet, presentation, and database applications; strong verbal and written communication skills; strong analytical skills; the ability to lead a team; the ability to manage multiple assignments with competing deadlines; strong interpersonal skills, including the ability to represent and present to organizational leadership; and the ability to identify and resolve complex problems using independent judgement.

Equal Employment & Opportunity:

The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.

Benefits:

Employees are offered a comprehensive benefits package that includes medical, dental and vision coverage, short- and long-term disability, life insurance, 401(k) savings plans, flexible spending accounts, and tuition reimbursement or educational assistance. Employees are also eligible for annual incentive compensation based on annual business goals. Additionally, employees receive eight hours of paid volunteer time each year, access to an on‑staff health coach and personal trainer, plus many other perks.

Delta Dental is an Equal Opportunity Employer.