Senior Encounter Data Specialist

Job Description

Job Description

Senior Encounter Data Specialist

Location: Okemos, MI (Hybrid: Mon-Thurs OS)

Position Overview

A growing healthcare organization is seeking a Senior Encounter Data Specialist to support the accuracy, integrity, and compliance of encounter data submissions. This role is responsible for analyzing, correcting, and resolving encounter data issues while collaborating with internal teams and external stakeholders to ensure regulatory compliance and data quality.

The ideal candidate will have strong analytical skills, experience working with healthcare claims or encounter data, and the ability to identify root causes and implement process improvements.

Key Responsibilities:

• Review, research, and correct rejected encounter records in accordance with established guidelines and industry best practices.
• Analyze encounter data to identify discrepancies, trends, and potential submission issues.
• Monitor and audit encounter submissions to ensure timely and accurate processing.
• Maintain and update encounter-related policies, procedures, and documentation.
• Support data maintenance activities related to providers, eligibility, benefits, fee schedules, and other system records.
• Conduct root cause analyses on encounter data errors and collaborate with cross-functional teams to implement corrective actions.
• Develop and maintain an encounter error library, reporting tools, and process documentation.
• Generate daily, weekly, and ad hoc reports related to encounter data quality and performance.
• Identify trends in rejected encounters and recommend process improvements to reduce future errors.
• Develop and test audit reports and data validation tools to improve submission accuracy.
• Partner with internal departments and external stakeholders to resolve data issues and maintain compliance standards.
• Serve as a subject matter expert on encounter data processes, regulatory requirements, and system configurations.
• Provide training and guidance to internal teams regarding encounter data requirements and process updates.
• Participate in compliance meetings, audits, and special projects as needed.
• Ensure adherence to data integrity standards and organizational policies.

Required Qualifications:

• Bachelor's degree in Healthcare Administration, Business, Information Systems, or a related field preferred.
• 2+ years of experience working with EDI transactions and healthcare data exchange processes.
• Experience working within Medicaid, Medicare, or other government-sponsored healthcare program environments.
• Experience working with healthcare claims, encounter data , managed care, or medical billing processes.
• Strong analytical, problem-solving, and investigative skills.
• Experience researching, interpreting, and resolving healthcare data issues.
• Proficiency with Microsoft Excel and reporting tools.
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
• Excellent written and verbal communication skills.
• Experience with encounter data submission, validation, and reconciliation processes.
• Knowledge of healthcare EDI transactions, including 837 claims and related encounter reporting requirements.
• Experience working with regulatory and compliance requirements related to Medicaid and Medicare programs.
• Familiarity with healthcare claims systems, provider data, eligibility data, and benefit configuration.

What You'll Bring:

• Detail-oriented approach with a strong focus on data accuracy and integrity.
• Ability to identify trends, investigate root causes, and implement effective solutions.
• Strong collaboration skills and the ability to work effectively across departments and with external stakeholders.
• Continuous improvement mindset with a passion for solving complex data issues.
• Ability to work independently while maintaining compliance with internal and external requirements.

Company Description

Branex Group is a Minority-owned Technical Staffing firm headquartered in Auburn Hills, MI. We are a Certified Women’s Owned Business through the Women’s Business Enterprise National Council (WBENC). We specialize in Engineering, Information Technology, Robotics, Human Resources, and Finance opportunities across the United States.

Branex Group is committed to being an Equal Employment Opportunity Employer and fostering a diverse and inclusive workplace. We ensure all applicants and employees are considered without discrimination or harassment based on race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran status, disability status, genetics, or any other protected characteristic by State and Federal laws.

Branex Group offers the following benefits:
- Medical Insurance
- Dental Insurance
- Vision insurance
- Paid time off
- 401(k)

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Company Description

Branex Group is a Minority-owned Technical Staffing firm headquartered in Auburn Hills, MI. We are a Certified Women’s Owned Business through the Women’s Business Enterprise National Council (WBENC). We specialize in Engineering, Information Technology, Robotics, Human Resources, and Finance opportunities across the United States.\r\n\r\nBranex Group is committed to being an Equal Employment Opportunity Employer and fostering a diverse and inclusive workplace. We ensure all applicants and employees are considered without discrimination or harassment based on race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran status, disability status, genetics, or any other protected characteristic by State and Federal laws.\r\n\r\n\r\nBranex Group offers the following benefits:\r\n- Medical Insurance\r\n- Dental Insurance\r\n- Vision insurance\r\n- Paid time off\r\n- 401(k)\r\n\r\n This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.