Expert Systems Analyst

Job TitleSystems Analyst – CMS Encounter ImplementationJob SummaryThe 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.Key ResponsibilitiesImplementation & ConfigurationLead requirements gathering sessions with internal and client stakeholders to define CMS encounter submission needsDocument and maintain detailed business and technical requirements for encounter implementationsDefine encounter submission specifications aligned to CMS guidelines and client-specific configurationsPerform gap analysis between source system data and CMS encounter requirementsData Mapping & TestingDevelop 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 workflowsValidate test files and analyze CMS response files (999, 277CA, MAO feedback)Identify, document, and support resolution of validation and compliance issues during implementationTechnical & Analytical SupportWrite and execute SQL queries to analyze source data, validate mappings, and reconcile test resultsPartner with engineering and data teams to troubleshoot data transformation or processing issuesSupport configuration and validation of encounter processing pipelines and submission schedulesGo-Live Readiness & TransitionSupport implementation readiness activities, including dependency tracking, risk identification, and mitigation planningDocument implementation outcomes, assumptions, and known limitationsCoordinate handoff from implementation to operations or BPO teams following go-liveEnsure implementation documentation supports long-term operational successClient & Cross-Functional CollaborationServe as an implementation subject matter expert for CMS encounter submissionsProvide clear, timely communication on implementation status, risks, and dependenciesParticipate in client-facing meetings to review testing results, readiness criteria, and go-live planningRequired QualificationsBachelor’s degree in information systems, Healthcare Administration, Computer Science, or equivalent practical experience3+ years of experience supporting healthcare data implementations or payer technology solutionsStrong knowledge of CMS encounter submissions, Medicare Advantage, and/or ACA programsHands-on experience with ANSI X12 transactions, particularly 837 encounter filesStrong SQL skills with demonstrated experience in data validation, analysis, and troubleshootingAbility to interpret CMS validation logic and regulatory requirements and apply them to implementation workExcellent written and verbal communication skills, with the ability to produce clear, accurate documentationStrong analytical and problem-solving skills, including the ability to interpret complex data and identify actionable insightsDemonstrated ability to work independently with minimal supervisionProven self-starter who proactively identifies work, resolves issues, and drives tasks through to completionAbility to analyze complex information and make sound, data-driven decisions in a fast-paced implementation environmentPreferred QualificationsDirect experience supporting CMS MA encounter submission implementationsFamiliarity with CMS acknowledgment and response files (999, 277CA, MAO reports)Experience working in implementation, consulting, or project-based delivery environmentsKnowledge of ETL processes, data integration tools, or healthcare data platformsTravel RequirementsLess than 10% travel Working ArrangementsWork will be performed in a standard office environment. ComplianceJob responsibilities include fostering the Company’s compliance with all applicable laws and regulations, adherence to the Code of Conduct and Compliance Program requirements, policies and procedures. Compliance is everyone’s responsibility.Compensation Range$92,972-$129,231Compensation for this job is subject to market conditions, geographic considerations, the candidate’s unique skills and experience, state and local laws, and budget. Our commitment to pay transparency is a testament to our dedication to creating a fair, equitable, and inclusive workplace. By continuously analyzing market trends, staying abreast of changes in state laws, and making budgetary adjustments accordingly, we strive to ensure that our compensation practices reflect the value we place on our associates’ unique contributions and support their professional growth.Enhancing Lives and Building CareersVeradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network. Interested in learning more?Take a look at our Culture, Benefits, Early Talent Program, and Additional Openings.We strongly advocate that our associates receive all CDC recommended vaccinations in prevention of COVID-19.Visa Sponsorship is not offered for this position.At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve. The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.Veradigm’s policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.From a "VEVRAA Federal Contractor" We request Priority Referral of Protected VeteransThis is an official Veradigm Job posting. To avoid identity theft, please only consider applying to jobs posted on our official corporate site.Thank you for reviewing this Veradigm opportunity. Does this look like a great match for your skill set? If so, scroll on down and tell us more about yourself!