Encounter Data Specialist

WelbeHealth•Remote, CA, USA, CA

4d•Onsite

About The Position

The Encounter Data Specialist is a key member of the WelbeHealth configuration team, and is accountable for supporting and ensuring the successful and compliant submission of encounter data reporting to both CMS (federal) and state agencies. This role is different because the Encounter Data Specialist at WelbeHealth plays a critical role in ensuring accurate and compliant encounter data submissions, directly supporting organizational compliance, reporting integrity, and operational success within a highly regulated healthcare environment. They partner cross-functionally with internal teams and external vendors to investigate encounter submission issues, identify root causes, resolve data discrepancies, and support scalable encounter reporting processes as WelbeHealth continues to grow.

Requirements

High school diploma or equivalent
Minimum of three (3) years of experience with encounter data submissions and resolution; five (5) years of experience as a healthcare claims supervisor or above may be substituted
Excellent organizational, time management, and communication skills
Proficient with office and electronic communication (i.e., Excel and Microsoft Office)
Ability to work independently with minimal supervision
Demonstrated ability to prioritize in a fast-paced environment

Nice To Haves

Detail-oriented, analytical, and collaborative, with a strong understanding of encounter data processes, claims operations, and regulatory requirements.

Responsibilities

Ensure encounter data submissions meet federal and state requirements
Analyze and interpret encounter data errors to identify potential issues and trends
Review and resolve encounter errors in a timely manner to achieve and maintain high encounter submission acceptance rates
Monitor monthly federal and state encounter data reports and create an error resolution plan
Stay informed of federal and state updates for encounter data rules and regulations
Work closely with both internal and external partners to identify issues and perform root cause analyses on encounter rejections related to claims data and eligibility
Support new implementations of encounter submissions to CMS and state necessary to accommodate company growth