Systems Analyst - Payer Encounter Management Platform

Veradigm

10d

About The Position

The Systems Analyst supports enterprise customers using Veradigm’s Encounter Management Platform, providing post-sales installation, configuration, upgrades, troubleshooting, and day-to-day operational assistance. The role takes a proactive lead in coordinating with Engineering and customers to triage and resolve complex technical and application issues affecting product performance or broader customer adoption. The analyst also partners with Development, Sustaining Engineering, and Sales Engineering to resolve support issues, document bugs, provide user acceptance testing on product builds, and help ensure successful new and upgraded server installations. The role supports encounter data reporting and submission processes for EDPS, RAPS, and the EDGE server, including analysis and reconciliation of claims and encounter data, data validation, rejection resolution, and monitoring submission deadlines. It involves investigating customer environments and raw data files, reproducing issues in controlled test environments, conducting remote troubleshooting sessions, and providing responsive customer support. The analyst also assists with ACA and Medicare Advantage submissions and helps customers understand CMS filtering and risk-adjustment processes.

Requirements

Bachelor’s degree in Health IT, Informatics, Management Information Systems, or a related field.
At least 2 years of professional experience in Risk Adjustment data management.
Understanding of claims data, encounter response files, 837 EDI encounter files, EDGE/Medicare Advantage billing and business rules, and Medicare Advantage filtering logic for EDPS.
Experience with the CMS submissions process and EDI transactions.
Strong time-management and organizational skills.
Experience troubleshooting performance problems with potential causes involving disk, database, network, messaging, and other platform or third-party solutions.
Experience managing product back ends and web services.
Ability to guide customers remotely through complex, multi-server enterprise product deployments and upgrades.
Familiarity with EDI standards such as X12, EDIFACT, HL7, and NCPDP, and knowledge of HIPAA transactions.
Knowledge of 837 transactions, their loops and segments, and CMS requirements for EDPS submission files.
Good written and verbal communication skills.

Nice To Haves

Working knowledge of SQL scripts.
Knowledge of CMS model changes.
Knowledge of CMS risk scores and Risk Adjustment methodologies.
Knowledge of Medicaid.

Responsibilities

Support encounter data reporting for EDPS, RAPS, and the EDGE server, including tracking, reporting, and resolving rejections.
Conduct gap analysis and data validation, identify potential data-submission issues, and determine financial impact.
Analyze and reconcile claims and encounter data, including 837 EDI encounter files and files for EDPS, RAPS, and EDGE server submissions.
Research issues in the encounter management system and liaise with the CSSC Helpdesk to resolve exceptions.
Work with raw data files in their native formats and access them through various servers.
Partner with Product Support Engineers and development teams as needed.
Assist the development team with performance analysis and testing during release cycles, including service packs and hot fixes.
Respond to customer requests for help by email and phone.
Collaborate virtually with other Product Support staff.
Host online troubleshooting and investigation sessions in customers’ production environments.
Provide a consistent, responsive, and satisfying customer experience with each contact.
Collect the problem details needed to investigate and resolve customer issues.
Reproduce customer issues in a controlled test environment.
Follow standard operational procedures for case management.
Continuously improve troubleshooting skills, product expertise, and knowledge of related technical topics.
Perform ACA and Medicare Advantage submissions for clients.
Understand CMS RAPS and EDPS filtering logic used for risk adjustment and risk-score calculations.
Monitor CMS data-submission deadlines for Medicare Advantage and ACA lines of business.
Assist enterprise customers with post-sales installation, configuration, upgrades, troubleshooting, and operational management of the platform.
Coordinate with Engineering and customers to triage and resolve complex technical and application issues.
Document bugs, provide UAT on product builds, and help ensure successful new and upgraded server installations.