Sr Systems Analyst - Payer Health Plan (ACA & Medicare) - Remote

Allscripts; Raleigh (NC); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player in healthcare technology is seeking a dedicated professional to provide technical support and manage data related to risk adjustment. This role offers the chance to work with innovative artificial intelligence technologies while ensuring the accuracy of claims and encounter data. As part of a supportive team, you will collaborate with engineering and development to tackle complex challenges, making a significant impact on client satisfaction and operational efficiency. If you are passionate about advancing your career in a dynamic environment, this opportunity is perfect for you.

Benefits

Comprehensive benefits package

Remote work flexibility

Supportive work environment

Career advancement opportunities

Qualifications

• 5+ years of experience in Risk Adjustment data management.
• Bachelor’s Degree in relevant field is required.

Responsibilities

• Provide technical support to enterprise clients regarding product operations.
• Conduct gap analysis and data validation, resolving data submission issues.

Skills

Data Management

Communication Skills

Time Management

Technical Support

Education

Bachelor’s Degree in Health IT/Informatics/Management Information Systems

Tools

EDI Standards (X12, EDIFACT, HL7)

ETL Tools

Job description

Employer Industry: Healthcare Technology

Why consider this job opportunity:

1. Opportunity for career advancement and growth within the organization
2. Comprehensive benefits package including medical, dental, and vision insurance
3. Remote work flexibility
4. Supportive and collaborative work environment
5. Chance to work with cutting-edge artificial intelligence technologies in healthcare

What to Expect (Job Responsibilities):

1. Provide technical support to enterprise clients related to operational aspects of the products
2. Conduct gap analysis and data validation, identifying issues in data submissions
3. Analyze and reconcile claims and encounter data including 837 EDI encounter files
4. Collaborate with engineering and development teams to resolve complex technical issues
5. Host online troubleshooting sessions and deliver a consistent customer experience

What is Required (Qualifications):

1. Bachelor’s Degree in Health IT/Informatics/Management Information Systems or related field
2. 5+ years of professional experience in Risk Adjustment data management
3. Understanding of claims data, encounter response files, and CMS submissions processes
4. Excellent time management and organizational skills
5. Strong written and verbal communication skills

How to Stand Out (Preferred Qualifications):

1. Familiarity with EDI Standards such as X12, EDIFACT, and HL7
2. Knowledge of various network technologies and communication protocols
3. Experience with managing product back end and web services
4. Prior experience with ETL and Mapping
5. Knowledge of Medicaid and CMS Risk Score methodologies