Encounter Data Specialist

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. Delta Dental is one of the largest dental plan administrators in the country and is part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation.

We celebrate an All‑In culture—an attitude that underpins everything we do, from advancing our careers to supporting colleagues and giving back to the community.

Job Title: Encounter Data Specialist
Location: Okemos, MI (Hybrid Position)
Number of Positions: 1

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

• Correct rejected encounters in compliance with internal and external processing guidelines and best practices.
• Research, review, and interpret encounter data to identify potential issues and address rejected records.
• Monitor, manage, and audit encounter submissions to ensure timely and accurate file submission and processing.
• Develop and maintain encounter policies and procedures.
• Monitor related processes to meet requirements, partner with functional areas to maintain claims system support tables, and perform data entry for eligibility, providers, fee sets, and benefits records.
• Conduct root cause analysis for encounter errors, review results, processes, and/or system programming with other departments to minimize repeat issues.
• Create and maintain an encounter error library, policies, and procedures to correct rejected encounters, and produce daily and weekly reports.
• Analyze trends of rejected encounters, identify opportunities for improvement, and recommend solutions.
• Develop and test internal audit and Integrated Data Management reports to prevent rejections and oversee the completion of audit reports in other departments.
• Establish and maintain strong relationships with internal and external plans, partners, and other stakeholders to correct, prevent, and resolve encounter errors.
• Serve as a subject matter expert and internal consultant on encounter data, policies, processes, corrections, and provide training to internal stakeholders regarding regulatory changes.
• Lead and participate in encounter data and compliance meetings as assigned.
• Oversee compliance with data integrity policies for all system configurations.

Perform other related duties as necessary to complete the Primary Job Responsibilities.

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 Medicare and/or Medicaid programs and Centers for Medicare & Medicaid Services 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 judgment.

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.