Senior Encounter Data Specialist

Number of Positions: 1

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.

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

• Represents the encounter team to leadership by presenting reports, project progress, metrics, deliverables, and other encounter-related updates.
• Leads and oversees the correction of rejected encounters by researching, reviewing, and interpreting encounter data, identifying potential issues, and ensuring corrections comply with internal and external processing guidelines and best practices.
• Monitors, manages, and audits encounter submissions to ensure timely, accurate file submission and processing.
• Leads encounter implementation activities for new customer onboarding, driving cross-functional coordination and ensuring deliverables align with internal standards, regulatory expectations, and external customer requirements.
• Serves as a key subject matter expert during internal and external audits by coordinating requested materials, completing audit responses, preparing supporting documentation, presenting findings, and monitoring audit-related reports to demonstrate compliance with audit requirements.
• Provides oversight of electronic data interchange (EDI) and X12 data exchange compliance, ensuring encounter transactions adhere to applicable industry regulations, HIPAA requirements, and partner-specific mandates.
• Monitors the development, implementation, maintenance, and application of encounter policies, procedures, error libraries, and reporting tools to correct rejected encounters and support daily and weekly operational oversight.
• 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, benefits and related records.
• Oversees root cause analysis for encounter errors and reviews results, processes, and/or system programming with other departments to minimize repeat issues, identify opportunities for improvement, and recommend solutions.
• 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, compliance, and corrections, develops training for internal stakeholders regarding regulatory changes, and 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, internal controls, regulatory compliance, and general principles.
• Comm…