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Enrollment Encounter Data Analyst

Upper Peninsula Health Plan Marquette, MI

Marquette, MI

Today

$22+/hr Full time Analytics Data Data Analysis

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Job Description

The Enrollment Encounter Data Analyst is responsible for compiling, analyzing, trending, tracking, and interpreting Medicare-Medicaid Plan and Medicaid enrollment activities. The role also researches, interprets, analyzes, and corrects pended and rejected Medicaid and Medicare encounters while supporting audits, reconciliations, and compliance-related processes.

Location and Compensation

Location: Marquette, MI (onsite)
Pay: USD 22.00 per hour
Additional compensation: Potential based on qualifications
Date: September 28, 2026

Key Responsibilities

Follow established UPHP policies and procedures, including objectives, safety standards, and sensitivity requirements for confidential information.
Ensure data integrity and accuracy in enrollment and encounter processes by analyzing potential system issues involving 834 and 837 transactions.
Serve as the subject matter expert and liaison for 834 audit and daily file reconciliations with the Michigan Department of Health & Human Services (MDHHS), and participate in enrollment and encounter workgroup meetings as needed.
Submit Medicaid service requests through CHAMPS to MDHHS regarding enrollment and/or payment issue discrepancies, including MI Health Link (MHL) discrepancies and immediate access of care issues between CMS and MDHHS.
Work with the encounter vendor and internal staff to support accurate and timely submission of encounter data, and analyze and resolve encounter pends/rejects in the encounter system.
Resolve verbal and written inquiries related to enrollment, encounter, and newborn activities from staff, providers, and members, and coordinate with claims staff to confirm incoming enrollment, provider, and claims data is accurate and complete.
Verify Maternity Case Rate (MCR) payments have been received for qualifying births and ensure newborn enrollment is handled appropriately.
Serve as Domain Administrator for CHAMPS.
Process member ID cards and new member packets.
Validate health plan material mailings by the print vendor, verify vendor invoices, and ensure print vendor compliance with contract requirements.
Partner with the Data Infrastructure (DI) team to test and validate 834 enrollment file and 837 encounter file changes to meet MDHHS and/or CMS requirements.
Act as liaison to external vendors regarding enrollment and encounter data when outreach is needed.
Support enrollment and encounter subject matter expertise for audits and compliance reviews.
Collaborate with the Risk Adjustment Analyst & Coding Compliance Auditor to interpret and correct errors within risk adjustment and encounter data processing systems.
Participate in Revenue Reconciliation and assist Finance in identifying and resolving capitation rate payment issues.
Work with Compliance and external vendors to identify and validate claim encounter activity for Program Integrity submissions to MDHHS.
Maintain written documentation of activities and revise procedures and policies to improve efficiency and incorporate changes.
Apply for Wisconsin Medicaid on behalf of a TPA Client, WI Department of Corrections, and incarcerated individuals while inpatient status.
Maintain confidentiality of client data and perform other related duties as assigned.

Required Qualifications

Education: Associate degree in health information processing, computer information systems, accounting, business, or related field. Five (5) years of relevant experience in lieu of a degree will be considered.
Experience: Two (2) to four (4) years of claims management, information systems, accounting, or relevant experience.
Keyboarding proficiency and working knowledge of MS Office (Word, Excel, Access, and PowerPoint).
Excellent human relations and oral/written communication skills.
Excellent organizational abilities with attention to detail.
Medical terminology knowledge.
Ability to work independently and prioritize tasks with minimal supervision.

Preferred Qualifications

Bachelor’s degree in health information management, computer information systems, accounting, or related field.
Four (4) to six (6) years of experience reporting, analyzing, interpreting, and presenting data.
Experience analyzing large data files and performing file reconciliations.
Knowledge of CPT, HCPCS, ICD-10 coding; revenue codes; DRG; UB-04; and CMS-1500 claims submission, including electronic claims submissions.
Knowledge of APC reimbursement methodology, and MSA and CMS policy.
Orientation to managed care and health care systems.

Tools, Systems, and Technologies

834 transactions
837 transactions
Community Health Automated Medicaid Processing System (CHAMPS)
MI Health Link (MHL)
MS Office (Word, Excel, Access, and PowerPoint)
CPT, HCPCS, ICD-10
UB-04, CMS-1500

Working Conditions and Physical Requirements

Office-based working conditions.
Exposure to clients and others who may require exceptional interpersonal skills.
Subject to many interruptions.
Occasional travel may be required.
Ability to enter and access information from a computer.
Ability to access all areas of UPHP offices.
Occasionally lifts supplies/equipment.
Prolonged periods of sitting.
Manual dexterity.

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