RA Encounter Data System Senior Analyst

Corewell Health • Grand Rapids, MI

23h • Onsite

About The Position

The Risk Adjustment (RA) Senior Encounter Data Systems Analyst plays a key role within the Risk Adjustment (RA) Encounters team, managing and enhancing the full lifecycle of the Encounter Data Submission process across all applicable lines of business. This position requires deep knowledge of regulatory requirements and strong technical and analytical skills to ensure accurate, compliant data submissions. The role involves evaluating upstream business processes, conducting advanced root cause analysis, and supporting other analysts through knowledge sharing and guidance on documentation, troubleshooting, and data quality practices. As a business owner of the Encounter Data Submission system, this analyst is responsible for translating business needs into clear, actionable requirements. This includes developing and maintaining Business Requirements Documents (BRDs), Functional Requirements Documents (FRDs), and Business Requirements Mapping Documents (BRMDs) that trace data from intake through business logic to mandated outputs. The role also manages routine and ad-hoc processing, investigates and resolves internal and government edits, maintains application and database servers, supports software upgrades, and performs user acceptance and unit testing. The position works closely with cross-functional teams and external vendors to resolve pended transactions, document incidents, and improve data quality and operational efficiency. Proficiency in SQL, data querying, and reporting is essential, along with a solid understanding of HIPAA 5010 EDI formats (837P, 837I, 837D), 999, 277, MAO-002, XML, and ACA Encounter Data structures. This role requires the ability to clearly communicate complex findings and recommendations to both technical and non-technical stakeholders, including senior leadership.

Requirements

• Bachelor's Degree or equivalent in business, liberal arts, computer science, application programming, software development, information systems, database administration, mathematics, engineering, or other related field, or equivalent work experience
• 3 years of relevant experience in the Encounter Data Processing of outbound and response transaction: State 837, Edge XML, CMS EDPS 837, MMP, ect field or 5 years of relevant experience IT systems, databases, analytics, or related encounter data submission and resolution experience.
• Preferably with large, complex data sources

Responsibilities

• Serves as the business product owner for the Encounter Data Submission system, overseeing the routine and ad-hoc creation and submission of encounter data across all domains, including Enrollment, Medical Claims, Pharmacy, and Chart Review.
• Leads comprehensive reconciliation efforts and root cause analysis for data system issues and submission incidents, including internal and external (government) edit rejections.
• Manages relationships with cross-functional teams to ensure accurate and timely resolution of Encounter Data Submission issues; reviews and updates documentation for upstream business processes that impact data inputs.
• Acts as Encounters Subject Matter Expert with the Encounter Data Submission system IT vendor, reviewing incident reports, contributing to backlog refinement, and supporting release management activities.
• Designs and develops operational reports to support full-cycle reconciliation of encounter data, including source inputs, data batches, file submissions, and response files.
• Creates dashboards and executive-level reporting to communicate key encounter data metrics and performance indicators to senior leadership.
• Plans, tests, and supports ETL processes, including the design of table structures and data workflows to support encounter data ingestion and transformation.
• Identifies and assesses the impact of incidents within the core Encounter Data Submission system; collaborates with IT vendors to refine backlog items and implement new market or regulatory submission requirements.
• Supports system integration efforts by leading data validation, testing, and implementation of new functionality or submission requirements.
• Troubleshoots and resolves production issues related to encounter data and supporting applications, ensuring minimal disruption to submission processes.
• Evaluates and advises on short-term workaround strategies to address Encounter Data Submission issues while long-term solutions are developed.

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees