Healthcare Data Systems Analyst

1 week ago

Pensacola, United States Veradigm Full time

Healthcare Data Systems Analyst - Remote 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 is an innovative Healthcare Analytics and Technology Company that delivers visibility and transparency for Risk Adjustment and Quality Management programs. We enable health plans and at-risk providers to achieve the greatest financial impact in the Health Insurance Exchange (HIX), Medicare Advantage, and Medicaid markets. By combining advanced analytic methodologies with extensive health plan experience, Veradigm has developed a suite of uniquely pragmatic solutions that are revolutionizing risk adjustment. Veradigm flexible business intelligence tools offer real-time visibility into member and provider activities so our clients can apply the most cost-effective and appropriate interventions for closing gaps in documentation, coding, and quality. Job Summary Join the Payer Team as a System Analyst, providing expert support to BPO clients in managing claims submissions. In this role, you'll serve as a critical liaison between client teams and internal systems, ensuring seamless communication and operational alignment. Success requires deep knowledge of ACA-related data workflows, Medicare and Medicaid programs, and healthcare technology platforms. You'll apply your technical expertise in requirements gathering, gap analysis, data mapping, and SQL to support accurate and compliant claims processing. A strong understanding of claims file structures and submission protocols is essential, along with the ability to quickly identify and resolve issues. This role demands ownership, adaptability, and clear, confident communication to guide clients through complex data challenges. Key Responsibilities Inbound Source File Oversight Escalation and Collaboration Data Validation & Edits Encounter & Supplemental File Submission Response & Report File Management Risk Analysis & Reporting Qualifications Bachelor's degree in health information management, Data Analytics, or a related field. 2+ years' healthcare technology industry experience. 2+ years' experience working with ACA and Medicare/Medicaid programs. Familiarity with CMS/ACA submission protocols and 837 file formats. Experience with ACA Edge Server environments, including validation. Strong analytical skills and attention to detail. Experience with FTP, data validation tools, and ticketing systems (e.g., JIRA, ServiceNow). Excellent communication and client-facing skills. Demonstrates initiative. Takes ownership of responsibilities. Ability to follow up to ensure tasks are completed. Proactively seeks clarification to ensure full understanding. Confident in posing thoughtful, sometimes difficult questions to address gaps or surface critical issues. Preferred Skills Knowledge of PHI handling and HIPAA compliance. Experience with Medicare Advantage or Medicaid encounter data. Ability to interpret Statements of Work (SOWs) and translate into operational workflows. Proficiency in Excel, SQL, or data visualization tools.

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