Senior 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. As part of the Delta Dental Plans Association, we operate two of the largest dental networks in the nation. Our mission is supported by an All In culture, where we take charge of our careers, help colleagues, and give back to the community.

Location

Location: Okemos, MI
Position Type: Hybrid

Primary Job Responsibilities

• Represents encounter team to leadership, presenting reports, project progress, metrics, and other deliverables.
• Leads the correction of rejected encounters in compliance with internal and external processing guidelines and best practices.
• Oversees the team’s efforts in researching, reviewing, and interpreting encounter data to identify potential issues and address rejected records.
• Maintains encounter submissions to ensure timely and accurate file submission and processing.
• Monitors, manages, and audits encounter submissions to ensure internal and external requirements are met.
• Partners with functional areas to maintain claims system support tables and coordinates data entry or general data maintenance for eligibility, providers, fee sets, and benefits for related records.
• Oversees the root cause analysis for encounter errors and reviews results, processes, and/or system programming with other departments to minimize repeat issues.
• Develops and maintains the encounter error library, policies, and procedures to correct rejected encounters, and prepares daily and weekly reports.
• Conducts trend analysis of rejected encounters and develops reports to identify opportunities for improvement, and recommends solutions.
• Maintains 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 lead subject matter expert and key internal consultant on encounter data, policies, processes, corrections, and develops training for internal stakeholders regarding regulatory changes.
• Coordinates and leads encounter data and compliance meetings.
• Leders compliance with data integrity policies for all system configurations.
• Recruits new encounter data staff, including interviewing, selection, onboarding, and training.
• Affirms adherence to company policies and internal controls, regulatory compliance, and general principles.
• Communicates and manages encounter deliverables to ensure compliance with state requirements and contract SLAs.

Minimum Requirements

• Bachelor’s degree in business administration or a related field.
• Seven 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.