Systems Analyst - Payer Encounter Management Platform

📋 Description

• • As a Systems Analyst for Veradigm's Payer Encounter Management Platform, you will be instrumental in ensuring the seamless operation and successful adoption of our cutting-edge healthcare technology solutions for enterprise clients. This role is pivotal in bridging the gap between complex technical challenges and client success, directly impacting how health plans and at-risk providers manage critical data for Risk Adjustment and Quality outcomes across HIX, Medicare Advantage, and Medicaid programs. You will act as a proactive leader, collaborating with both internal engineering teams and external customers to resolve intricate, application-specific issues that affect product performance and broader client adoption, thereby upholding Veradigm's commitment to providing clear visibility into member and provider activity for efficient gap closure.
• • Your day-to-day responsibilities will encompass a wide range of critical tasks aimed at supporting and optimizing the Encounter Management Platform. This includes actively supporting encounter data reporting processes for EDPS, RAPS, and the EDGE server, meticulously tracking, reporting, and resolving any data rejections to ensure compliance and accuracy. You will conduct thorough gap analyses and data validation exercises, proactively identifying potential issues within data submissions and quantifying their financial implications. A significant part of your role will involve analyzing and reconciling claims and encounter data, specifically working with 837 EDI encounter files destined for EDPS, RAPS, and Edge Server submission. You will perform in-depth research within the encounter management system and serve as the primary liaison with the CSSC Helpdesk for efficient exception resolution, demonstrating a strong ability to work with raw data files in their native format and access them through various server environments. Furthermore, you will partner closely with Product Support Engineers and development teams to address technical challenges, assist the development team with performance analysis and testing during release cycles for service packs and hot fixes, and provide crucial User Acceptance Testing (UAT) on product builds. You will be the first point of contact for customers, answering email and phone requests for assistance, and will host online troubleshooting and investigation sessions directly on customer production environments, ensuring a consistent, responsive, and satisfying customer experience with every interaction. To effectively resolve issues, you will meticulously collect all necessary problem details from customers and successfully reproduce customer issues in a controlled test environment, adhering to standard operational procedures for case management. Your role also involves continuous improvement of your troubleshooting skills, product expertise, and knowledge of related technical topics, alongside performing ACA and MA Submissions for Clients and monitoring CMS data submission deadlines for both MA and ACA lines of business. A key aspect of your contribution will be understanding the RAPS and EDPS filtering logic that CMS utilizes for Risk Adjustment and/or Risk Score calculations.
• • You will be an integral part of a dynamic team dedicated to Veradigm's mission of transforming healthcare through advanced analytics and technology. Veradigm is a leading healthcare analytics and technology company focused on empowering health plans and at-risk providers to enhance Risk Adjustment and Quality outcomes. Our Encounter Management Platform is a cornerstone solution, centralizing the processing, validation, and submission of encounter and supplemental data for government programs like Medicare, Medicaid, and ACA. We pride ourselves on streamlining complex operations, offering a reliable and compliant pathway for managing large-scale encounter data. You will collaborate in virtual teamwork with other Product Support staff, contributing to a collective effort to deliver exceptional client support and drive product success. This collaborative environment fosters knowledge sharing and mutual support, ensuring that the team collectively meets and exceeds client expectations.
• • In this role, you will gain invaluable experience in the intricacies of healthcare data management, particularly within the complex regulatory landscape of Medicare Advantage and Medicaid. You will develop deep expertise in encounter data processing, risk adjustment methodologies, and CMS submission requirements, becoming a subject matter expert in the field. You will have the opportunity to hone your technical troubleshooting skills across various platforms and technologies, including databases, networks, and messaging systems. By working directly with enterprise customers and internal development teams, you will enhance your communication, problem-solving, and client management abilities. Successfully navigating and resolving complex technical issues will not only contribute to your professional growth but also directly impact the efficiency and effectiveness of our clients' operations, offering a tangible sense of achievement and career advancement within a growing and innovative company. You will also gain exposure to product development cycles, providing feedback and participating in UAT, which offers a unique perspective on product evolution.
• • This role offers a unique opportunity to deepen your understanding of the healthcare ecosystem, specifically focusing on the financial and operational aspects driven by accurate data submission and risk adjustment. You will become proficient in interpreting and manipulating complex data sets, understanding the nuances of EDI transactions and their impact on healthcare reimbursements and quality metrics. The ability to translate technical findings into actionable insights for both clients and internal teams will be a key development area. Furthermore, you will contribute to the continuous improvement of Veradigm's platform by providing critical feedback from the front lines of customer support, influencing future product development and enhancements. Your success in this role will be measured by your ability to resolve client issues efficiently, maintain high levels of customer satisfaction, and contribute to the overall stability and adoption of the Encounter Management Platform, positioning you for further growth within Veradigm's technical and client-facing career paths.