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. 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.

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.
• Maintains encounter policies and procedures.
• Monitors and audits encounter submissions to ensure timely and accurate file submission and processing.
• 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.
• Participates in encounter data and compliance meetings as assigned.
• Oversees compliance with data integrity policies for all system configurations.

Minimum Requirements

• A bachelor’s degree in business administration or a related field.
• 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.

Position Description

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