Encounter Data Specialist

At WelbeHealth, we serve our communities’ most vulnerable seniors through shared intention, pioneering spirit, and the courage to love. These core values and our participant-focus lead the way no matter what.

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
• Partners 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

We care about our team members. That’s why we offer:

• Medical insurance coverage (Medical, Dental, Vision)
• Work/life balance - We mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days
• 401K savings + match
• Comprehensive compensation package including base pay and bonus
• And additional benefits!

On the day-to-day, you will:

• 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

Job requirements include:

• 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

We are seeking an Encounter Data Specialist who is detail-oriented, analytical, and collaborative, with a strong understanding of encounter data processes, claims operations, and regulatory requirements. If you’re ready to join a team that values both its participants and team members, we’d love to hear from you!