Expert Systems Analyst

Veradigm•Raleigh, NC

1d•Onsite

About The Position

The Systems Analyst – CMS Encounter Implementation is responsible for supporting the end-to-end implementation of CMS encounter submissions for new and expanding payer clients. This role leads requirements gathering, data mapping, testing coordination, and go-live readiness activities to ensure encounter submissions meet CMS regulatory and validation requirements. The Systems Analyst partners closely with project management, engineering, data, and client teams throughout the implementation lifecycle—from discovery through production readiness.

Requirements

Bachelor’s degree in information systems, Healthcare Administration, Computer Science, or equivalent practical experience
3+ years of experience supporting healthcare data implementations or payer technology solutions
Strong knowledge of CMS encounter submissions, Medicare Advantage, and/or ACA programs
Hands-on experience with ANSI X12 transactions, particularly 837 encounter files
Strong SQL skills with demonstrated experience in data validation, analysis, and troubleshooting
Ability to interpret CMS validation logic and regulatory requirements and apply them to implementation work
Excellent written and verbal communication skills, with the ability to produce clear, accurate documentation
Strong analytical and problem-solving skills, including the ability to interpret complex data and identify actionable insights
Demonstrated ability to work independently with minimal supervision
Proven self-starter who proactively identifies work, resolves issues, and drives tasks through to completion
Ability to analyze complex information and make sound, data-driven decisions in a fast-paced implementation environment

Nice To Haves

Direct experience supporting CMS MA encounter submission implementations
Familiarity with CMS acknowledgment and response files (999, 277CA, MAO reports)
Experience working in implementation, consulting, or project-based delivery environments
Knowledge of ETL processes, data integration tools, or healthcare data platforms

Responsibilities

Lead requirements gathering sessions with internal and client stakeholders to define CMS encounter submission needs
Document and maintain detailed business and technical requirements for encounter implementations
Define encounter submission specifications aligned to CMS guidelines and client-specific configurations
Perform gap analysis between source system data and CMS encounter requirements
Develop and maintain detailed data mappings for CMS-compliant encounter files (e.g., 837P and 837I)
Support unit, integration, and user acceptance testing for encounter submission workflows
Validate test files and analyze CMS response files (999, 277CA, MAO feedback)
Identify, document, and support resolution of validation and compliance issues during implementation
Write and execute SQL queries to analyze source data, validate mappings, and reconcile test results
Partner with engineering and data teams to troubleshoot data transformation or processing issues
Support configuration and validation of encounter processing pipelines and submission schedules
Support implementation readiness activities, including dependency tracking, risk identification, and mitigation planning
Document implementation outcomes, assumptions, and known limitations
Coordinate handoff from implementation to operations or BPO teams following go-live
Ensure implementation documentation supports long-term operational success
Serve as an implementation subject matter expert for CMS encounter submissions
Provide clear, timely communication on implementation status, risks, and dependencies
Participate in client-facing meetings to review testing results, readiness criteria, and go-live planning