Data and specialist

Full job description

Position Purpose
The purpose of the Encounter Data and Ventilator Reporting Specialist is to ensure accurate and complete encounter and ventilator reporting for all Group Health Cooperative government program business lines. The Encounter Data Specialist will also analyze and validate data received from DHS.



Essential Position Functions

• Perform thorough analysis of all encounter and ventilator reporting received from DHS including but not limited to: Response Files, Activity Reports, and actuarial extracts.
• Work with various departments (Claims, Compliance, Provider Relations, Government Programs, IT and Finance) to report findings and trend issues along with identifying possible solutions.
• Collaborate with Finance to reconcile encounter and ventilator data with DHS actuarial data, reports and other provided information.
• Reconcile DHS eligibility discrepancy report and complete appropriate follow-up with DHS.
• Participate in other related encounter data and ventilator reporting related projects.
• Responsible for encounter data and ventilator reporting for all government program product lines.
• Work with the state of Wisconsin VEDS support for encounter, ventilator, and eligibility related issues and questions.
• Participate in the DHS technical work groups.

Minimum Requirements of the Position

• Associates degree in accounting, health information technology or related field, or equivalent experience preferred;
• Three to four years experience in medical payment and processing systems (claims, enrollment, finance), or prior experience as an auditor;
• Knowledge of Medicaid and/or Medicare;
• Knowledge of the health insurance industry;
• Organized and attentive to detail;
• Knowledge of professional, hospital, and ancillary billing and reimbursement methodology including DRG, APC, ICD 10, CPT, HCPCS and other prospective billing experience is preferred;
• Proficiency with Microsoft Word and Excel is required;
• Must have proven problem solving skills;
• Excellent verbal and written communication skills.

This full time position offers an outstanding benefit package, including three weeks of vacation the first year, a generous retirement plan, health and dental insurance, a wellness program, and much more! If you are interested in working for an organization focused on a team atmosphere and is dedicated to providing exceptional service submit your resume today! Send resume to: . Group Health Cooperative of Eau Claire is an affirmative action and equal opportunity employer.


Group Health Cooperative of Eau Claire considers candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.