Systems Analyst - Payer Encounter Management Platform

Systems AnalystVeradigm is a healthcare analytics and technology company that helps health plans and at-risk providers improve Risk Adjustment and Quality outcomes across HIX, Medicare Advantage, and Medicaid. With advanced analytics and real-time intelligence, we give clients clear visibility into member and provider activity so they can close documentation, coding, and quality gaps more efficiently.The Veradigm Encounter Management Platform is a centralized solution that processes, validates, and submits encounter and supplemental data for Medicare, Medicaid, ACA, and other government programs. It streamlines ingestion, edit resolution, submission readiness, and CMS response handling, giving health plans and BPO partners a reliable, compliant way to manage large-scale encounter operations.Job SummaryThe 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 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's Encounter Management Platform. In addition to working with customers, the Systems Analyst will routinely partner with our Development, Sustaining 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.What You Will Contribute:Support encounter data reporting processes for EDPS, RAPS and the EDGE server, including tracking, reporting, and resolving rejectionsConduct 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 filesPerform research in the encounter management system and liaison with the CSSC Helpdesk for exception resolutionBe comfortable with raw data files in their native format and accessing these through various serversPartner with Product Support Engineers and development teams as necessaryAssist development team with performance analysis and testing during release cycles for service packs, hot fixes etcAnswer email and phone requests for help from customersCollaborate in virtual teamwork with other Product Support staffHost online troubleshooting and investigation sessions on customer's production environmentsDeliver a consistent, responsive and satisfying customer experience with each contactCollect all necessary problem details from customers to be able to effectively see the problem to resolutionSuccessfully reproduce customer issues in a controlled test environmentFollow standard operational procedures for case managementContinuously improve troubleshooting skills, product expertise, and knowledge on related technical topicsPerform ACA and MA Submissions for ClientsUnderstand RAPS and EDPS filtering logic which CMS uses for Risk Adjustment and/or Risk Score calculationsMonitor CMS data submission deadlines for both MA and ACA lines of businessThe Ideal Candidate Will Have:Academic and Professional Qualifications:· Bachelor's Degree in Health IT/Informatics/Management Information Systems or related field requiredExperience:2+ years of professional experience in Risk Adjustment data managementUnderstanding of claims data, encounter response files, 837 EDI encounter files, EDGE/MA billing & business rules as well as MA filtering logic for EDPSExperience with CMS Submissions Process and EDI transactionsExcellent time management and organizational skills necessaryPrior experience troubleshooting performance problems that may have many underlying causes such as Disk, Database, Network, Messaging and other platform / 3rd party solutionsExperience with managing product back end and webservicesAbility to guide customers remotely through complex, multi-server deployments and upgrades for enterprise productsFamiliarity with EDI Standards such as X12, EDIFACT, HL7, NCPDP and knowledge of HIPAA transactionsPrior knowledge of 837's along with various loops and segments and an understanding of the requirements set forth by CMS for EDPS submission filesWorking knowledge in SQL scripts is a plusGood written and verbal skills.Knowledge in CMS model changes is a plusKnowledge in CMS Risk Score and Risk Adjustment methodologies is a plusKnowledge in Medicaid is a plusTravel Requirements:Less than 5%Compensation Range:$69,852-$97,094Compensation for this job is subject to market conditions, geographic considerations, the candidate's unique skills and experience, state and local laws, and budget. Our commitment to pay transparency is a testament to our dedication to creating a fair, equitable, and inclusive workplace. By continuously analyzing market trends, staying abreast of changes in state laws, and making budgetary adjustments accordingly, we strive to ensure that our compensation practices reflect the value we place on our associates' unique contributions and support their professional growth.Enhancing Lives and Building CareersVeradigm 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.From a "VEVRAA Federal Contractor" We request Priority Referral of Protected VeteransThis is an official Veradigm Job posting. To avoid identity theft, please only consider applying to jobs posted on our official corporate site.Thank you for reviewing this Veradigm opportunity. Does this look like a great match for your skill set? If so, scroll on down and tell us more about yourself!