Systems Analyst – CMS Encounter Implementation

Location: Raleigh, NC; standard office environment. Applicants for North American-based positions must be legally authorized to work in the United States or Canada. Travel is less than 10%.

Salary: $92,972–$129,231 per year.

Company

hirify.global provides healthcare technology, data-driven solutions, and artificial intelligence technologies for healthcare providers, life science companies, health plans, and patients.

What you will do

• Lead requirements-gathering sessions and define CMS encounter submission specifications for new and expanding payer clients.
• Document business and technical requirements, perform source-data gap analysis, and maintain CMS-compliant mappings for 837P and 837I files.
• Coordinate unit, integration, and user acceptance testing; validate test files and analyze 999, 277CA, and MAO responses.
• Use SQL to analyze source data, validate mappings, reconcile results, and troubleshoot data transformation or processing issues with engineering and data teams.
• Support configuration of encounter-processing pipelines, submission schedules, risk tracking, and go-live readiness.
• Coordinate the transition from implementation to operations or BPO teams and participate in client-facing status and planning meetings.

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, and strong SQL skills for data validation and troubleshooting.
• Ability to interpret CMS validation logic and regulatory requirements, analyze complex information, and make data-driven decisions.
• Excellent written and verbal communication skills, independence, proactive problem-solving, and the ability to drive work to completion.

Nice to have

• Direct experience with CMS Medicare Advantage encounter submission implementations.
• Familiarity with CMS acknowledgment and response files, including 999, 277CA, and MAO reports.
• Experience in implementation, consulting, or project-based delivery environments.
• Knowledge of ETL processes, data integration tools, or healthcare data platforms.

Culture & Benefits

• Comprehensive compensation and benefits package.
• Medical, dental, and vision insurance.
• Company-paid life insurance and retirement savings.
• Holidays, vacation, and professional development support.
• Commitment to compliance, equal employment opportunity, and an inclusive workplace.