Systems Analyst - Payer Encounter Management Platform

LE1000 Veradigm LLC; United States; Remote; USD 69,852 - 97,094; Full time

Benefits offered by this job

Medical, dental and vision insurance

Retirement savings plans

Paid holidays and vacation

Job summary

LE1000 Veradigm LLC seeks a Systems Analyst to manage customer installations, configurations, and data processes for its Encounter Management Platform. You will troubleshoot complex issues, lead technical resolutions, and collaborate with various teams.

The ideal candidate has a Bachelor's Degree in related fields, a minimum of 2 years in Risk Adjustment data management, and expertise in claims data. Competitive compensation and benefits await.

Qualifications

• Minimum 2 years of experience in Risk Adjustment data management.
• Understanding of claims data and encounter response files.
• Experience with CMS Submissions Process and EDI transactions.

Responsibilities

• Take a proactive leadership role with the Engineering team.
• Conduct gap analysis and data validation for submissions.
• Collaborate with Development and Engineering organizations.

Skills

Risk Adjustment data management

EDPS filtering logic

Claims data understanding

Troubleshooting performance problems

Guiding remote deployments

Communication skills

Education

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

Tools

SQL scripts

Job description

Job Summary

Veradigm’s Systems Analyst works primarily with enterprise customers of Veradigm’s Encounter Management Platform, proactively assisting them with post‑sales installation, configuration, upgrade, troubleshooting and day‑to‑day operational management.

Responsibilities

• Take a proactive leadership role with the Engineering team and customers to triage and resolve highly complex, technical, and application‑related issues that impact product performance in customer‑specific environments or hamper broader customer adoption of the Encounter Management Platform.
• Partner routinely with Development, Sustaining Engineering and Sales Engineering organizations to resolve support issues, document bugs, provide UAT on product builds, and ensure that new and upgraded server installations are successful.
• 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, including 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 them 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 effectively see the problem through 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 used by CMS for Risk Adjustment and/or Risk Score calculations.
• Monitor CMS data submission deadlines for both MA and ACA lines of business.
• Travel Requirements: less than 5% of the time.

Qualifications

• Bachelor’s Degree in Health IT, Informatics, Management Information Systems or a related field.
• Minimum 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, and MA filtering logic for EDPS.
• Experience with CMS Submissions Process and EDI transactions.
• Excellent time‑management and organizational skills.
• Prior experience troubleshooting performance problems such as Disk, Database, Network, Messaging and other platform or third‑party solutions.
• Experience 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 with various loops and segments and the requirements set forth by CMS for EDPS submission files.
• Working knowledge of SQL scripts is a plus.
• Good written and verbal communication skills.
• Knowledge of CMS model changes, CMS Risk Score and Risk Adjustment methodologies, and Medicaid is a plus.

Compensation

Salary range: $69,852 – $97,094. Compensation is subject to market conditions, geographic considerations, candidate’s unique skills and experience, state and local laws, and budget. Pay transparency practices ensure that compensation reflects the value of each associate’s contributions.

Benefits

Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental and vision insurance, company‑paid life insurance, and retirement savings plans.

Equal Opportunity Employer

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. Applicants for North‑American based positions must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire.

Visa Sponsorship

Visa sponsorship is not offered for this position.