Analysis Skills, Cloud Computing, Content Management Systems (CMS), Data Analysis, Data Quality, Healthcare, Healthcare Administration, Maintain Compliance, Medical Office Administration, Medicare, Microsoft Windows Azure, Reconciliation, Regulatory Compliance, Regulatory Reports, Regulatory Submissions, SQL (Structured Query Language), Software Development, Software Engineering, Systems Administration/Management, Technical Analysis, Utilization Management
Job Title: Application Developer / Software Engineer
Location: Remote
Job Description:
Job Summary
We are seeking an experienced Technical Analyst with strong expertise in healthcare payer systems, compliance reporting, and data analysis. The ideal candidate will have hands-on experience with regulatory submissions, healthcare workflows, and modern data platforms to support compliance and reporting needs.
Key Responsibilities
- Manage and support medical management compliance reporting, including regulatory submissions such as ODAG, CDAG, and CMS
- Analyze and interpret healthcare data related to Medicare Advantage, Utilization Management (UM), and Care Management (CM) processes
- Develop, validate, and reconcile data using SQL to ensure accuracy and completeness of reports
- Collaborate with business stakeholders and technical teams to identify data gaps and implement solutions
- Work with core healthcare administration platforms such as MHK (MedHOK), IKA, QNXT, or Facets
- Support regulatory audits and compliance cycles, including CMS audits and validation processes
- Contribute to data modernization initiatives leveraging cloud platforms like Azure
- Ensure adherence to regulatory guidelines, data governance standards, and internal compliance policies
- Participate in end-to-end reporting lifecycle, including data extraction, transformation, validation, and submission
Required Skills & Experience
- 8+ years of experience in medical management compliance reporting and regulatory submissions (ODAG, CDAG, CMS)
- 6+ years of experience in the healthcare payer domain, with strong knowledge of Medicare Advantage, UM, and CM workflows
- Strong proficiency in SQL, data validation, reconciliation, and reporting
- Hands-on experience with healthcare platforms such as MHK (MedHOK), IKA, QNXT, or Facets
- Experience with Azure or modern data platforms
- Solid understanding of CMS audits, compliance validations, and submission cycles
Preferred Qualifications
- Prior experience in the healthcare industry (payer domain preferred)
- Exposure to large-scale data transformation or modernization projects
A
Axelon Services Corporation