Systems Analyst (Healthcare)

Location: Raleigh, NC. Applicants for North American positions must be legally authorized to work in the United States or Canada. Travel is less than 5%.

Salary: $69,852–$97,094 per year.

Company

hirify.global provides healthcare analytics and technology solutions for health plans, providers, and government healthcare programs.

What you will do

• Support encounter data reporting and submissions for EDPS, RAPS, EDGE, ACA, and Medicare Advantage programs.
• Analyze and reconcile claims, encounter data, rejection files, and 837 EDI submission files.
• Perform gap analysis and data validation to identify submission issues and assess financial impact.
• Troubleshoot complex application and performance issues across customer-specific, multi-server environments.
• Partner with customers, product support, development, sustaining engineering, and sales engineering teams to resolve cases and reproduce defects.
• Support release testing, service packs, hot fixes, server installations, upgrades, and CMS submission deadlines.

Requirements

• Bachelor’s degree in Health IT, Informatics, Management Information Systems, or a related field.
• At least 2 years of professional experience in risk adjustment data management.
• Understanding of claims data, encounter response files, 837 EDI files, EDGE and MA billing rules, and EDPS filtering logic.
• Experience with CMS submission processes, EDI transactions, HIPAA transactions, and standards such as X12, EDIFACT, HL7, or NCPDP.
• Experience troubleshooting performance issues involving disks, databases, networks, messaging, and third-party platforms.
• Ability to guide customers through complex deployments and upgrades and manage product backends and web services.

Nice to have

• Working knowledge of SQL scripting.
• Knowledge of CMS model changes, risk score and risk adjustment methodologies, or Medicaid.

Culture & Benefits

• Medical, dental, and vision insurance.
• Company-paid life insurance and retirement savings benefits.
• Holidays and vacation time.
• Professional development support and workplace flexibility.
• Inclusive and equal-opportunity workplace.