Medicare MACs Lead SME - CMS Operations & Policy

Peraton; Idaho; Hybrid; USD 146,000 - 234,000; Full time

Job summary

Peraton is seeking a highly experienced Subject Matter Expert (SME) specializing in Medicare Administrative Contractors (MACs) to support mission‑critical CMS operations across the Medicare Fee‑For‑Service (FFS) ecosystem. As the nation’s leading mission capability integrator and trusted partner, Peraton relies on SMEs to provide authoritative knowledge on MAC functions and CMS interfacing.

The role requires deep program operations experience, data‑driven analysis, and the ability to guide

Qualifications

• Extensive knowledge of Medicare FFS program operations and CMS contractor structures.
• Experience with all claim types: Part A, Part B, Home Health & Hospice, DME.
• Expertise in claims adjudication, provider enrollment workflows, appeals processes, medical review, and coverage determination development.
• Experience with Medicare Claims Pricing, CMS Web Pricer, Prospective Payment Systems and Fee Schedules.
• Demonstrated experience working with CMS, Medicare contractors, or large federal health programs.
• Understanding MAC relationships with RACs, UPICs, QIOs, QICs, VDCs, SMRCs, etc.
• Strong familiarity with CMS regulations, guidance, and acquisition requirements.
• Proven ability to communicate complex program information to diverse stakeholders including federal customers.

Responsibilities

• Serve as lead expert on the purpose, structure, and scope of MACs and their role as CMS’s interface with providers.
• Advise project teams on MAC operational responsibilities such as claims processing, payment accounting, provider enrollment, appeals, medical review, and LCD development.
• Provide insight on MAC scale, claim volumes, provider populations, and Medicare FFS disbursements for program analysis.
• Guide teams in understanding MAC relationships with functional contractors across the FFS landscape.
• Interpret CMS procurement requirements and regulations guiding MAC evolution under programs.
• Partner with project managers, analysts, and technical leads to evaluate MAC operations and identify enhancements.
• Contribute SME input to solution development, proposals, requirements, risk analysis, and customer deliverables.
• Advance Peraton’s mission by clarifying MAC operations and their impact on interoperability and data flows.

Skills

Medicare FFS operations

MAC/FFS knowledge

Claims adjudication

Provider enrollment workflows

Appeals processes

Medical review

Coverage determination development

CMS regulations familiarity

Stakeholder communication

Public Trust clearance readiness

Education

BS/BA degree

High School diploma with equivalent experience

Job description

Peraton is seeking a highly experienced Subject Matter Expert (SME) specializing in Medicare Administrative Contractors (MACs) to support mission‑critical CMS operations across the Medicare Fee‑For‑Service (FFS) ecosystem. As the nation’s leading mission capability integrator and trusted partner, Peraton relies on SMEs to provide authoritative knowledge on MAC functions and CMS interfacing.

The role requires deep program operations experience, data‑driven analysis, and the ability to guide