Systems Analyst - CMS Encounter Implementation

GoTo Meeting; Raleigh (NC); On-site; USD 92,972 - 129,231; Full time

Job summary

GoTo Meeting in Raleigh, NC seeks a Systems Analyst responsible for implementing CMS encounter submissions for new and expanding payer clients. This role involves requirements gathering, data mapping, and ensuring compliance with CMS regulations.

The ideal candidate has a Bachelor's degree, 3+ years experience in healthcare data implementations, and strong SQL skills. The role requires excellent communication and analytical abilities to successfully coordinate implementation activities.

Qualifications

• 3+ years of experience supporting healthcare data implementations or payer technology solutions.
• Strong knowledge of CMS encounter submissions and Medicare Advantage.
• Hands-on experience with ANSI X12 transactions.
• Excellent written and verbal communication skills.

Responsibilities

• Lead requirements gathering sessions with stakeholders.
• Document business and technical requirements for encounter implementations.
• Develop detailed data mappings for CMS-compliant encounter files.
• Support unit, integration, and user acceptance testing.

Skills

CMS encounter submissions

SQL

Data validation

Healthcare data implementations

Analytical skills

Education

Bachelor’s degree in information systems or equivalent

Job description

Systems Analyst – CMS Encounter Implementation

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.

Key Responsibilities

Implementation & Configuration

• 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

Data Mapping & Testing

• 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

Technical & Analytical Support

• 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

Go‑Live Readiness & Transition

• 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

Client & Cross‑Functional Collaboration

• 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

Required Qualifications

• 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

Preferred Qualifications

• 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

Travel Requirements

Less than 10% travel

Working Arrangements

Work will be performed in a standard office environment.

Compliance

Job 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-$129,231

Compensation 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.

Visa Sponsorship is not offered for this position.

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.