Systems Analyst - Health Plans & Payer

Systems Analyst - Health Plans & Payer

Location: Remote - US

Position Type: Full time

Requisition : JR10243

Veradigm 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 Summary

The 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 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, 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 these 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 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
• Perform ACA and MA Submissions for Clients
• Understand RAPS and 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:

• 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 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,…