D+H

Expert Systems Analyst

D+H$92K — $129K *
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's degree in information systems, Healthcare Administration, Computer Science, or equivalent experience
  • 3+ years of experience in healthcare data implementations or payer technology solutions
  • Strong knowledge of CMS encounter submissions and related programs
  • Hands-on experience with ANSI X12 transactions, particularly 837 encounter files
  • Strong SQL skills for data validation and analysis
  • Ability to interpret and apply CMS regulatory requirements
  • Excellent written and verbal communication skills

Responsibilities

  • Lead requirements gathering sessions with stakeholders for CMS encounter submissions
  • Document and maintain detailed business and technical requirements
  • Define encounter submission specifications aligned with CMS guidelines
  • Develop and maintain data mappings for CMS-compliant encounter files
  • Support testing activities for encounter submission workflows
  • Write and execute SQL queries for data analysis and validation
  • Coordinate implementation handoff from project to operational teams

Benefits

  • Less than 10% travel requirement
  • Standard office working environment
  • Fostering compliance with applicable laws and regulations as a core responsibility
Full Job Description
Job Title

Systems Analyst - CMS Encounter Implementation

Job Summary

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.

About D+H

D+H is committed to being the technology partner that financial services organizations trust and rely on to build deeper and more profitable relationships with their own customers. In 1875, when D+H was founded, They may have looked a lot different than we do today, but the core of that commitment – being a trusted provider to our customers – has never changed. They have remained committed to delivering solutions that power our customers’ businesses in increasingly competitive markets. They are proud of their strong and vibrant history - it drives their culture and the way they do business today.

Veradigm Careers

Joining Veradigm presents an unparalleled opportunity to advance a career in healthcare technology with a company at the forefront of innovation and leadership. Veradigm, a leader in providing cutting-edge healthcare solutions, offers a range of job opportunities designed to empower professional growth and personal achievement.

Explore Career Opportunities

Veradigm is actively hiring and seeks professionals who are passionate about making a significant impact in the healthcare industry. With a variety of positions available, from technical roles to customer support, Veradigm ensures that every team member can find a place to excel.

Internship Programs

Veradigm's internship programs offer a robust introduction to the healthcare technology sector, providing hands-on experience and valuable networking opportunities. Interns at Veradigm gain practical skills and knowledge, setting the stage for future employment in a dynamic and evolving industry.

Professional Growth and Development

Veradigm is committed to the professional growth of its employees, offering extensive training and development programs. These initiatives are designed to enhance skills and foster innovation, ensuring that every team member can achieve their career aspirations within the company.

Diversity and Inclusion

At Veradigm, diversity is celebrated and actively promoted through comprehensive diversity training programs. The company believes that a diverse team enriches the workplace culture and drives the innovation that Veradigm is known for.

Benefits and Culture

Employees at Veradigm enjoy a range of benefits that support both their professional and personal lives. The company culture emphasizes teamwork, leadership, and the well-being of its staff, creating an environment where individuals can thrive.

Applying for a Position

Candidates interested in joining Veradigm are encouraged to explore available job opportunities on the Veradigm Careers page. The application process typically involves submitting a resume, completing an interview, and demonstrating how one's skills and experiences align with the company's needs.

Stay Connected with Veradigm Jobs

To stay informed about new openings and company news, potential candidates can sign up for job alert emails. These updates provide insights into Veradigm and highlight how the company continues to lead and innovate within the healthcare sector.

Networking and Career Advancement

Veradigm supports a vibrant professional community where networking and peer interactions are encouraged. This community helps foster relationships that can lead to career advancement and continued employment opportunities within the company.

Join the Veradigm Team

Veradigm is looking for curious, creative, and solution-driven team players. Search open positions that match your skills and interests on the Veradigm Jobs portal and discover how you can contribute to a leader in healthcare technology.

READ CAREERS BLOG

Stay ahead with career tips, insider perspectives, and industry-leading insights you can put to use today—all from the people who work at Veradigm. Explore how Veradigm is shaping the future of healthcare and how you can be a part of this exciting journey.
Learn more about D+H
Industry
Founded
1875

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