Rhsc
Senior Encounter Data Specialist
Okemos, MI · Senior
Sponsorship not specifiedDetected 30 days ago
ComplianceAuditingLeadershipCommunicationPublic SpeakingInternal Audit
About the role
- 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.
Responsibilities
- Leads the correction of rejected encounters in compliance with internal and external processing guidelines and best practices.
- Monitors, manages, and audits encounter submissions to ensure timely and accurate file submission and processing.
- Conducts trend analysis of rejected encounters and develops reports to identify opportunities for improvement, and recommends 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, corrections, and develops training for internal stakeholders regarding regulatory changes.
- Coordinates and leads encounter data and compliance meetings.
- Leads the recruitment process for new encounter data staff, including interviewing, selection, onboarding and training.
- 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.
Requirements
- Position requires knowledge of word processing, spreadsheet, presentation, and database applications
- 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.
Nice to have
- Previous experience in the administration of Medicare and/or Medicaid programs and Centers for Medicare and Medicaid regulations and guidelines is preferred.
Company info
- Assures adherence to company policies and internal controls, regulatory compliance, and general principles.
Visa & Work Authorization
- out 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, he
This listing is sourced directly from Rhsc's careers page and normalized into a canonical job model.