Data Analyst, Systems

About The CompanyVeradigm is a leading Healthcare Analytics and Technology Company dedicated to transforming healthcare through innovative data-driven solutions. Our mission is to provide transparency, visibility, and actionable insights to stakeholders across the healthcare spectrum, including biopharma, health plans, providers, and patients. By leveraging advanced analytics, artificial intelligence, and research, we develop scalable solutions that address the complex challenges faced by the healthcare industry. Our focus on risk adjustment and quality management programs enables health plans and at-risk providers to optimize financial outcomes while ensuring compliance and improving patient care. With a commitment to innovation, Veradigm continuously enhances its offerings to support smarter healthcare decisions and better health outcomes for millions of individuals.About The RoleWe are seeking a Healthcare Data Systems Analyst to join our remote team within the Payer Department. In this critical role, you will serve as a liaison between clients and internal systems, providing expert support in managing claims submissions and data workflows related to ACA, Medicare, and Medicaid programs. Your responsibilities will include overseeing inbound claim files, validating data, managing encounter and supplemental submissions, and analyzing claims data gaps. Your technical expertise in data validation, SQL, and healthcare claims processing will ensure accurate, compliant, and timely claims management. The ideal candidate will possess strong analytical skills, excellent communication abilities, and a proactive approach to problem-solving. This position offers an opportunity to contribute to impactful healthcare solutions while working remotely in a collaborative environment.QualificationsBachelor's degree in health information management, Data Analytics, or a related fieldMinimum of 2 years of experience in the healthcare technology industryAt least 2 years of experience working with ACA, Medicare, and Medicaid programsFamiliarity with CMS/ACA submission protocols and 837 file formatsExperience with ACA Edge Server environments and validation processesStrong analytical skills with keen attention to detailProficiency with FTP, data validation tools, and ticketing systems such as JIRA or ServiceNowExcellent client-facing communication skillsAbility to take ownership of tasks and demonstrate initiativeProactive in follow-up and clarification to ensure task completion and understandingConfident in posing questions to identify gaps and resolve issuesResponsibilitiesMonitor and manage inbound claim files on FTP servers, ensuring timely uploads according to schedulesValidate file volumes against claim estimates and enrollment dataTrack missing or failed files and support root cause analysis (RCA) for upload issuesCollaborate with internal subject matter experts and client teams to escalate discrepancies and resolve UI issuesParticipate in client calls to provide updates, clarify issues, and support resolution effortsUpdate documentation and contribute to process improvements based on feedbackManage duplicate records, versioning logic, and validate data using system-generated reportsCoordinate with clients to interpret record-level guidance and correct unrepairable errors in source systemsIdentify records eligible for submission and generate encounter and supplemental files for CMSMaintain comprehensive audit trails for all submissions and resubmissionsResubmit failed files based on CMS feedback and manage post-submission errorsLoad and process CMS response files, applying mitigation tactics for errorsFlag unrepairable records to support quality and statistical reportingAnalyze claims data gaps, validate alignment with scope of work, and interpret dashboard reportsRecommend best practices based on data trends and root cause analysis findingsBenefitsComprehensive health, dental, and vision insurance plansPaid holidays and vacation leaveRetirement savings plansCompany-paid life insuranceFlexible work environment with remote work optionsProfessional development and career growth opportunitiesInclusive and diverse workplace cultureEqual OpportunityVeradigm is an equal opportunity employer committed to fostering an inclusive environment. We do not discriminate based on race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, disability, sexual orientation, gender identity, or any other legally protected category. We promote diversity and equal employment opportunities for all applicants and employees.