Subject Matter Expert – Medicare Administrative Contractors (MACs)

Peraton; United States; Remote; 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 CMS operations across the Medicare FFS ecosystem. This role provides authoritative knowledge on MAC functions, regulations, and interactions that underpin Peraton's CMS program teams.

You will guide project teams on MAC responsibilities, support solution development, and contribute to proposals, requirements analysis, risk assessment, and customer-facing

Qualifications

• Minimum of 12 years with BS/BA; or 16 years with a high school diploma.
• Extensive knowledge of Medicare FFS program operations and CMS contractor structures.
• Experience with all claim types: Part A, Part B, Home Health & Hospice, Railroad Board, DME
• Expertise in claims adjudication, provider enrollment workflows, appeals, medical review, and coverage determination development.
• Experience with Medicare Claims Pricing, CMS Web Pricer, Prospective Payment Systems and Fee Schedules
• Demonstrated experience working with or supporting CMS, Medicare contractors, or large federal health programs.
• Understanding MAC relationships with RACs, UPICs, QIOs, QICs, VDCs, SMRCs, etc.
• Understanding edits used by MACs and working suspense codes
• Understanding reporting needs/uses from claims systems
• Understanding Provider and/or Bene workflows for claims processing and payments
• Strong familiarity with CMS regulations, guidance, and acquisition requirements.
• Proven ability to communicate complex program information to diverse stakeholders including federal customers, program managers, and multi-disciplinary teams.
• Ability to obtain a Public Trust clearance.
• US Citizen or Green Card Holder.

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 FFS benefit disbursements.
• Guide teams on MAC relationships with RACs, UPICs, VDCs, QIOs, QICs, SMRCs, BCRC, CCO, and HIGLAS.
• Support CMS procurement and MAC evolution by interpreting CMS requirements and guidance.
• Partner with managers to evaluate MAC operations and identify enhancements.
• Contribute SME to solution development, proposals, requirements analysis, risk, playbooks, and customer-facing deliverables.
• Clarify MAC operations and data flows to advance Peraton's mission.

Skills

Medicare MAC operations

Regulatory knowledge

Stakeholder communication

Public Trust clearance

US citizenship or GC

Education

BS/BA

High school diploma

Tools

CMS Web Pricer

Medicare claims pricing tools

Job description

Responsibilities

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 the industry partner trusted to deliver complex federal health programs, Peraton relies on SMEs to provide deep operational expertise, strategic guidance, and data-driven insights. This role ensures that Peraton's CMS program teams, project managers, and technical leads have authoritative knowledge on MAC functions, regulations, and interactions that underpin the Medicare FFS operational environment.

Key Responsibilities:

• Serve as lead expert on the purpose, structure, and scope of Medicare Administrative Contractors (MACs), including A/B MACs and DME MACs, and their critical role as CMS's primary operational interface with providers.
• Advise project teams on MAC operational responsibilities such as claims processing, payment accounting, provider enrollment, appeals (redeterminations), medical review, provider education, and the development of Local Coverage Determinations.
• Provide insight on MAC scale, claim volumes, provider populations, and Medicare FFS benefit disbursements to support Peraton's program analysis and performance evaluations.
• Guide teams in understanding MAC relationships with key functional contractors in the Medicare FFS ecosystem, including RACs, UPICs, VDCs, QIOs, QICs, SMRCs, BCRC, CCO, and HIGLAS.
• Support project's federal contracting and compliance activities by interpreting CMS procurement requirements, regulations, historical guidance, and the evolution of MACs under the Medicare Prescription Drug Improvement and Modernization Act.
• Partner with area project managers, analysts, and technical leads to evaluate MAC operations, identify areas for operational enhancement, and ensure alignment with CMS program goals and contractor obligations.
• Contribute subject matter expertise to solution development, proposal writing, requirements analysis, risk identification, operational playbooks, technical documentation, and customer-facing deliverables.
• Advance Peraton's mission by ensuring teams understand how MACs operate as the hub of Medicare FFS activities and how this affects interoperability, data flows, and program performance.

Qualifications

Required Experience and Qualifications

• Minimum of 12 years with BS/BA; or 16 years of experience with a high school diploma.
• Extensive knowledge of Medicare Fee-For-Service program operations and CMS contractor structures.
• Experience with all claim types: Part A, Part B, Home Health & Hospice, Railroad Board, 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 or supporting CMS, Medicare contractors, or large federal health programs.
• Understanding of MAC relationships with key functional contractors across the FFS landscape (RACs, UPICs, QIOs, QICs, VDCs, SMRCs, etc.).
• Understanding of edits used by MACs and working suspense codes
• Understanding of reporting needs/uses from claims systems
• Understanding of Provider and/or Bene workflows for claims processing and payments
• Strong familiarity with CMS regulations, guidance, and acquisition requirements.
• Proven ability to communicate complex program information to diverse stakeholders including federal customers, program managers, and multi-disciplinary teams.
• Ability to obtain a Public Trust clearance.
• US Citizen or Green Card Holder.

Preferred Qualifications

• Experience with specific claims workflow processes for NGS/WellPoint Federal and workload balancing/assignments
• Experience with specific systems built by NGS/WellPoint Federal to help automate claims processing
• Direct experience with MAC operations, oversight, or support.
• Background in Medicare policy, health care administration, program integrity, or government contracting.

Peraton Overview

Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world's leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can't be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we're keeping people around the world safe and secure.

Target Salary Range

$146,000 - $234,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual's experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.

EEO

EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.