Sr Systems Analyst - Remote
Allscripts
- Philadelphia, PA
- Permanent
- Full-time
- Deliver insights to drive quality outcomes cost-effectively
- Improve efficiency for themselves, their providers, and their members through high-speed clinical data exchange
- Impact point-of-care decision making positively by integrating payer guidance and prior authorization management directly in each healthcare provider's existing workflow
- Support encounter data reporting processes for EDPS, 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, 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.
- Provide technical support to enterprise clients related to technical and operational aspects of the products.
- 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
- Update knowledge base / create reusable documents, originating from patterns observed during customer issue troubleshooting
- Perform ACA and MA Submissions for Clients
- Understand and keep track of CMS model changes which details about eligible Risk Adjustment codes (diagnosis, CPT, HCPCS, etc.,) for submissions.
- Review and understand periodic CMS software releases which impact both the ACA and MA submissions.
- Understand 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.
- 5+ 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 at least one non-Windows operating system (such as Linux, HPUX, AIX)
- Familiarity with EDI Standards such as X12, EDIFACT, HL7, NCPDP and knowledge of HIPAA transactions.
- Knowledge of various network and internet technologies and communication protocols: TCP/IP, SFTP, HTTP, AS2, etc. highly desired.
- 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
- Prior experience with ETL and Mapping
- Excellent working knowledge of SQL
- Very strong written and verbal skills.
- Knowledge in CMS model changes is a plus
- Knowledge of CMS Risk Score and Risk Adjustment methodologies is a plus.
- Knowledge of Medicaid is a plus and having a good understanding and work experience on the Medicaid is a great added value.