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

Allscripts; United States; Remote; USD 80,000 - 110,000; Full time

Job summary

Join an innovative healthcare technology firm as a Senior Systems Analyst, where you'll play a pivotal role in supporting enterprise customers with their encounter management systems. This remote position offers the chance to work with cutting-edge data solutions that enhance healthcare delivery. You will analyze complex data submissions, troubleshoot technical issues, and collaborate with engineering teams to ensure seamless product performance. If you have a passion for healthcare technology and a knack for problem-solving, this opportunity is perfect for you. Be part of a team dedicated to transforming healthcare through technology and analytics.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

Company Paid Life Insurance

Retirement Savings

Paid Holidays

Vacation Days

Qualifications

• 5+ years experience in Risk Adjustment data management.
• Strong understanding of claims data and EDI transactions.
• Excellent troubleshooting and time management skills.

Responsibilities

• Support encounter data reporting processes and resolve rejections.
• Analyze and reconcile claims and encounter data.
• Provide technical support and collaborate with product teams.

Skills

Risk Adjustment Data Management

Claims Data Analysis

Technical Support

SQL

EDI Standards

Data Validation

Time Management

Troubleshooting

Education

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

Tools

CMS Submissions Process

Encounter Management Systems

Various Servers

Job description

Welcome to Veradigm, where our Mission is transforming health, insightfully. Join the Veradigm team and help solve many of today’s healthcare challenges being addressed by biopharma, health plans, healthcare providers, health technology partners, and the patients they serve. At Veradigm, our primary focus is on harnessing the power of research, analytics, and artificial intelligence (AI) to develop scalable data-driven solutions that bring significant value to all healthcare stakeholders. Together, we can transform healthcare and enable smarter care for millions of people.

Veradigm Payer

Veradigm understands that managed care organizations, pharmacy benefit managers (PBMs), insurance companies, health plans, and other payers need to balance controlling costs with the goal of providing the highest quality of care and optimizing health outcomes for their members.

Solutions from Veradigm Payers:

• Deliver insights to drive quality outcomes cost-effectively
• Improve efficiency for themselves, their providers, and their members through high-speed clinical data exchange
• Impact point-of-care decision making positively by integrating payer guidance and prior authorization management directly in each healthcare provider’s existing workflow

Job Summary

Join the Payer Health Plan Customer Support team as a Sr Systems Analyst working with enterprise customers of Veradigm Comprehensive Submissions Encounter Management Platform, proactively assisting them with post- sales installation, configuration, upgrade, troubleshooting and day to day operational management.

Responsibilities include taking a proactive leadership role working with the engineering team and customers to triage and resolve highly complex, technical, and application-related issues which impact product performance in customer-specific environments, or issues that directly hamper a broader customer adoption of Veradigm Comprehensive Submissions Encounter Management Platform. In addition to working with customers, the analyst will routinely partner with our development, engineering and sales engineering organizations to resolve support issues, document bugs, provide UAT on product builds, and ensure that new and newly upgraded server installations are successful.

This is a remote role.

What you will contribute:

• Support encounter data reporting processes for EDPS, 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, 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.
• Provide technical support to enterprise clients related to technical and operational aspects of the products.
• 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
• Update knowledge base / create reusable documents, originating from patterns observed during customer issue troubleshooting
• Perform ACA and MA Submissions for Clients
• Understand and keep track of CMS model changes which details about eligible Risk Adjustment codes (diagnosis, CPT, HCPCS, etc.,) for submissions.
• Review and understand periodic CMS software releases which impact both the ACA and MA submissions.
• Understand 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.

The ideal candidate will have:

Academic and Professional Qualifications:

· Bachelor’s Degree in Health IT/Informatics/Management Information Systems or related field required

Experience:

• 5+ 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 at least one non-Windows operating system (such as Linux, HPUX, AIX)
• Familiarity with EDI Standards such as X12, EDIFACT, HL7, NCPDP and knowledge of HIPAA transactions.
• Knowledge of various network and internet technologies and communication protocols: TCP/IP, SFTP, HTTP, AS2, etc. highly desired.
• 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
• Prior experience with ETL and Mapping
• Excellent working knowledge of SQL
• Very strong written and verbal skills.
• Knowledge in CMS model changes is a plus
• Knowledge of CMS Risk Score and Risk Adjustment methodologies is a plus.
• Knowledge of Medicaid is a plus and having a good understanding and work experience on the Medicaid is a great added value.

Travel Requirements:

· Will travel to Company head quarter for new hire orientation and if there are any specific training or customer meetings.

Working Arrangements:

· Monday through Friday or as defined by assignment requirements

Compliance
Job responsibilities include fostering the Company’s compliance with all applicable laws and regulations, adherence to the Code of Conduct and Compliance Program requirements, policies and procedures. Compliance is everyone’s responsibility.

Enhancing Lives and Building Careers

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network. Interested in learning more?

Take a look at our Culture, Benefits, Early Talent Program, and Additional Openings.

We strongly advocate that our associates receive all CDC recommended vaccinations in prevention of COVID-19.

Visa Sponsorship is not offered for this position.

At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve. The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.

Veradigm’s policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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