Healthcare Data Systems Analyst - Remote

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Healthcare Data Systems Analyst - Remote in the United States.

In this role, you will serve as a critical bridge between client teams and internal systems, ensuring seamless management of healthcare claims and data workflows. You will leverage your expertise in ACA, Medicare, and Medicaid programs to validate, map, and process complex datasets accurately and efficiently. The position involves collaborating with internal SMEs and clients to resolve issues, optimize submissions, and enhance reporting capabilities. This role demands analytical precision, clear communication, and ownership of end-to-end data processes in a remote, fast-paced environment that directly impacts healthcare operations.

Accountabilities

·         Monitor and manage inbound healthcare data files, ensuring timely uploads and validating volume against enrollment and claims estimates.

·         Identify, track, and resolve missing or failed files while supporting root cause analysis (RCA) for discrepancies.

·         Collaborate with client teams and internal experts to escalate issues, clarify processes, and ensure smooth operational workflows.

·         Validate, correct, and manage duplicate or error-prone records using system-generated reports.

·         Generate and submit encounter and supplemental files to CMS, maintaining audit trails and resubmitting failed files as required.

·         Analyze data gaps, extract insights, and provide actionable recommendations to improve claim accuracy and operational efficiency.

·         Document processes, contribute to continuous improvement, and maintain compliance with submission protocols.

·         Bachelor’s degree in Health Information Management, Data Analytics, or a related field.

·         2+ years of experience in healthcare technology or data management, with ACA, Medicare, and Medicaid exposure.

·         Proficiency in CMS/ACA submission protocols, 837 file formats, and ACA Edge Server environments.

·         Strong analytical skills, attention to detail, and problem-solving ability.

·         Hands-on experience with SQL, FTP processes, data validation tools, and ticketing systems (e.g., JIRA, ServiceNow).

·         Excellent client-facing communication skills, proactive ownership, and ability to follow through on tasks.

·         Ability to ask thoughtful questions, clarify requirements, and provide confident guidance to clients and team members.

Preferred Skills:

·         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.

·         Familiarity with Excel, SQL, or data visualization tools.