Systems Analyst - Payer Encounter Management Platform

Responsibilities

• 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
• Aid 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
• Understand RAPS and EDPS filtering logic which CMS uses for Risk Adjustment and/or Risk Score calculations
• Maintain awareness of CMS data submission deadlines for both MA and ACA lines of business

Qualifications

• 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
• 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
• Working knowledge in SQL scripts is a plus
• 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