Healthcare Data Systems Analyst - Remote

Philadelphia, Pennsylvania, United States

Full-time

Remote

Entry, Mid Level

Veradigm is an innovative Healthcare Analytics and Technology Company focused on transforming health through research, analytics, and AI. The Healthcare Data Systems Analyst will provide expert support to BPO clients in managing claims submissions, ensuring seamless communication and operational alignment while applying technical expertise in data workflows and claims processing.

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Responsibilities

Monitor and manage inbound files placed on FTP servers.
Upload client files into internal systems, ensuring timely receipt per established schedules.
Validate file volume against claim estimates and enrollment figures.
Track missing or failed files and support RCA for upload issues.
Collaborate with internal SMEs and client teams to escalate UI discrepancies.
Attend client calls to provide updates, clarify issues, and support resolution efforts.
Contribute to process improvement through documentation updates and feedback loops.
Manage duplicate records and versioning logic.
Review and correct validation errors using system-generated reports.
Redirect unrepairable errors to clients for correction in source systems.
Partner with clients to interpret record-level guidance when needed.
Identify records eligible for submission.
Generate and submit encounter and supplemental files to CMS.
Maintain audit trails for all submissions and resubmissions.
Resubmit failed files based on CMS response feedback.
Load and process CMS response files.
Manage post-submission errors and apply mitigation tactics.
Flag and mark unrepairable records to support quality and statistical reporting.
Analyze gaps in claims data and validate alignment with SOW scope.
Extract and interpret dashboard and report data for internal and client use.
Recommend best practices based on data trends and RCA findings.

Qualification

Required

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 Follows 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

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.

Benefits

Holidays
Vacation
Medical
Dental
Vision insurance
Company paid life insurance
Retirement savings

Veradigm is an integrated data systems and services company that combines data-driven clinical insights with actionable tools to help healthcare stakeholders improve the quality, efficiency, and value of healthcare delivery—these stakeholders include biopharma, health plans, healthcare providers, network partners, and most importantly, the patients they serve.

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