Sr Systems Analyst – Payer Health Plan (ACA & Medicare) – Remote Position Available In Orange, Florida

Sr Systems Analyst – Payer Health Plan (ACA & Medicare) – Remote
Orlando, Florida, United States 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? 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.