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Systems Analyst – Health Plans, Payer
Location
United States
Posted
17 days ago
Salary
$69.9K - $97.1K / year
Job Description
Job 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
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