Systems Analyst – CMS Encounter Implementation

Key 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

Go-Live Readiness & Transition Support

• Implement readiness activities, including dependency tracking, risk identification, and mitigation planning
• Document implementation outcomes, assumptions, and known limitations
• Coverage of go-live
• 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