Job Title:
Senior Encounter Data Specialist

Number of Positions:
1

Location:
Okemos, MI

Location Specifics:
Hybrid Position

Position Description:

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

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 interpretation of encounter data to identify potential issues and address rejected records.
• Monitors, manages, and audits encounter submissions to ensure timely and accurate file submission and processing.
• Monitors the development, implementation and maintenance of encounter policies and procedures.
• 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, 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.
• Oversees the development and maintenance of the encounter error library, policies and procedures to correct rejected encounters, and daily and weekly reports.
• Conducts trend analysis of rejected encounters and develops reports to identify opportunities for improvement, and recommends solutions.
• Monitors the development and testing of 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.
• 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 and internal controls, regulatory compliance, and general principles.
• Communicates and manages encounter deliverables to ensure compliance with state requirements and contract SLAs.

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

#LI-Hybrid

Minimum Requirements:

Position requires a bachelor's degree in business administration or a related field and 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. 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 lead a team; the ability to manage multiple assignments with competing deadlines; strong interpersonal skills, including the ability to represent and present to organizational leadership; and the ability to identify and resolve complex problems using independent judgement.