About this role
Job Summary
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.
Essential Functions
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.
Qualifications
Required
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
How Corewell Health cares for you
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
Primary Location
SITE - Priority Health - 1231 E Beltline Ave NE - Grand RapidsDepartment Name
Risk Adjustment Executive - PH Managed BenefitsEmployment Type
Full timeShift
Day (United States of America)Weekly Scheduled Hours
40Hours of Work
9 a.m. to 5 p.m.Days Worked
Monday to FridayWeekend Frequency
N/ACURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
Other facts
About Corewell Health
People are at the heart of everything we do, and the inspiration for our legacy of outstanding outcomes, innovation, strong community partnerships, philanthropy and transparency. Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team of 65,000+ dedicated people—including more than 12,000 physicians and advanced practice providers and more than 15,500 nurses providing care and services in 21 hospitals, 300+ outpatient locations and several post-acute facilities—and Priority Health, a provider-sponsored health plan serving more than 1.3 million members. Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness. For more information, visit corewellhealth.org.
What you'll do
- The RA Encounter Data System Senior Analyst manages and enhances the Encounter Data Submission process, ensuring accurate and compliant data submissions. This role involves evaluating business processes, conducting root cause analysis, and supporting analysts with documentation and data quality practices.
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