Encounter Data Specialist

Encounter Data Specialist

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.

Analyzes, corrects, and recommends solutions to internal and external stakeholders regarding encounter data issues, policies, processes, requirements, and records.

Primary Job Responsibilities:

• Corrects rejected encounters in compliance with internal and external processing guidelines and best practices.
• Researches, reviews, and interprets 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.
• Develops, maintains, and updates all encounter policies and procedures.
• Monitors related processes to ensure internal and external requirements are met, partners with functional areas to maintain claims system support tables, and performs data entry or general data maintenance for eligibility, providers, fee sets, and benefits for related records.
• Conducts root cause analysis for encounter errors reviews results, processes, and/or system programming with other departments to minimize repeat issues.
• Creates and maintains an encounter error library, policies and procedures to correct rejected encounters, and daily and weekly reports.
• Analyzes trends of rejected encounters, identifies opportunities for improvement, and recommends solutions.
• Develops and tests 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 a subject matter expert and internal consultant on encounter data, policies, processes, corrections, and provides training to internal stakeholders regarding regulatory changes.
• Leads and participates in encounter data and compliance meetings as assigned.
• Oversees compliance with data integrity policies for all system configurations.

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 five 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 work independently and as part of a team; the ability to manage multiple assignments with competing deadlines; and the ability to identify and resolve complex problems using independent judgement.

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.