Business Systems Analyst - Medicare

Introduction:

The Business Systems Analyst - Medicare will serve as a lead expert on the purpose, structure, and scope of Medicare Administrative Contractors (Client), advising project teams on operational responsibilities, claims processing, payment systems, and provider enrollment. They will provide insight on Client scale, claim volumes, and Medicare FFS benefit disbursements to support program analysis and performance evaluations.

Responsibilities:

• Serve as lead expert on Client and their role as the primary operational interface with providers
• Advise project teams on Client operational responsibilities such as claims processing, payment accounting, provider enrollment, appeals, and medical review
• Provide insight on Client scale, claim volumes, provider populations, and Medicare FFS benefit disbursements
• Guide teams in understanding Client relationships with key functional contractors in the Medicare FFS ecosystem
• Support federal contracting and compliance activities by interpreting procurement requirements and regulations
• Collaborate with project managers, analysts, and technical leads to evaluate Client operations and ensure alignment with program goals
• Contribute subject matter expertise to solution development, proposal writing, requirements analysis, and customer-facing deliverables

Requirements:

Required Experience and Qualifications:

• Experience with all claim types: Part A, Part B, Home Health & Hospice, Railroad Board, DME
• Expertise in claims adjudication, provider enrollment workflows, appeals processes, and coverage determination development
• Experience with Medicare Claims Pricing, Web Pricer, Prospective Payment Systems, and Fee Schedules
• Experience working with or supporting Client, Medicare contractors, or large federal health programs
• Understanding of Client relationships with key functional contractors and reporting needs from claims systems
• Strong familiarity with regulations, guidance, and acquisition requirements
• Proven ability to communicate complex program information to diverse stakeholders

Preferred Qualifications:

• Direct experience with Client operations, oversight, or support
• Background in Medicare policy, health care administration, program integrity, or government contracting