[Remote] Systems Analyst - Health Plans & Payer

Note: The job is a remote job and is open to candidates in USA. Veradigm is a healthcare analytics and technology company that helps health plans and at-risk providers improve Risk Adjustment and Quality outcomes. The Systems Analyst will work primarily with enterprise customers of Veradigm’s Encounter Management Platform, assisting with post-sales installation, configuration, and troubleshooting while collaborating with various teams to resolve complex technical issues. Responsibilities • Support encounter data reporting processes for EDPS, RAPS and the EDGE server, including tracking, reporting, and resolving rejections • Conduct gap analysis and data validation, identifying possible issues in data submission and determining financial impact • Analyze and reconcile claims and encounter data which will include 837 EDI encounter files for EDPS, RAPS and Edge Server submission files • Perform research in the encounter management system and liaison with the CSSC Helpdesk for exception resolution • Be comfortable with raw data files in their native format and accessing these through various servers • Partner with Product Support Engineers and development teams as necessary • Assist development team with performance analysis and testing during release cycles for service packs, hot fixes etc • Answer email and phone requests for help from customers • Collaborate in virtual teamwork with other Product Support staff • Host online troubleshooting and investigation sessions on customer’s production environments • Deliver a consistent, responsive and satisfying customer experience with each contact • Collect all necessary problem details from customers to be able to effectively see the problem to resolution • Successfully reproduce customer issues in a controlled test environment • Follow standard operational procedures for case management • Continuously improve troubleshooting skills, product expertise, and knowledge on related technical topics • Perform ACA and MA Submissions for Clients • Understand RAPS and EDPS filtering logic which CMS uses for Risk Adjustment and/or Risk Score calculations • Monitor CMS data submission deadlines for both MA and ACA lines of business Skills • Bachelor's Degree in Health IT/Informatics/Management Information Systems or related field required • 2+ years of professional experience in Risk Adjustment data management • Understanding of claims data, encounter response files, 837 EDI encounter files, EDGE/MA billing & business rules as well as MA filtering logic for EDPS • Experience with CMS Submissions Process and EDI transactions • Excellent time management and organizational skills necessary • Prior experience troubleshooting performance problems that may have many underlying causes such as Disk, Database, Network, Messaging and other platform / 3rd party solutions • Experience with managing product back end and webservices • Ability to guide customers remotely through complex, multi-server deployments and upgrades for enterprise products • Familiarity with EDI Standards such as X12, EDIFACT, HL7, NCPDP and knowledge of HIPAA transactions • Prior knowledge of 837's along with various loops and segments and an understanding of the requirements set forth by CMS for EDPS submission files • Good written and verbal skills • Working knowledge in SQL scripts is a plus • Knowledge in CMS model changes is a plus • Knowledge in CMS Risk Score and Risk Adjustment methodologies is a plus • Knowledge in Medicaid is a plus Benefits • Holidays • Vacation • Medical • Dental • Vision insurance • Company paid life insurance • Retirement savings Company Overview • Veradigm is an integrated data systems and services company that combines data-driven clinical insights with actionable tools to help healthcare stakeholders improve the quality, efficiency, and value of healthcare delivery—these stakeholders include biopharma, health plans, healthcare providers, network partners, and most importantly, the patients they serve. It was founded in 1986, and is headquartered in Chicago, Illinois, USA, with a workforce of 1001-5000 employees. Its website is https://veradigm.com.