Systems Analyst – Health Plans, Payer

Job Description: • 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 Requirements: • Bachelor’s Degree in Health IT/Informatics/Management Information Systems or related field required • 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, 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 EDI Standards such as X12, EDIFACT, HL7, NCPDP and knowledge of HIPAA transactions • 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 • Working knowledge in SQL scripts is a plus • Good written and verbal skills. • Knowledge in CMS model changes is a plus • Knowledge in CMS Risk Score and Risk Adjustment methodologies is a plus • Knowledge in Medicaid is a plus Benefits: • Health insurance • 401(k) matching • Paid time off • Flexible work arrangements • Professional development opportunities