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Medicare Sme Jobs (NOW HIRING)

Conflux Systems

Medicare Domain SME

Medicare Domain SME Location: Jefferson City MO, USA - Remote MUST HAVE: * Medicare SME * Medicare Advantage * Enrolment * Premium Billing * CMS Guidelines * Capitation Revenue reconciliation

GDIT

Medicaid & Medicare Fraud Detection SME

WV · On-site +1

$148K - $201K/yr

No As a Functional Analyist SME the work you'll do at GDIT will be impactful to the mission of the Centers for Medicare and Medicaid Services (CMS). You will play a crucial role in leading teams ...

Oracle

Principal Consultant - Medicare

Kansas City, MO · On-site

As a Principal Consultant for Oracle Health, you will operate as the subject matter expert (SME) for Medicare and Medicare Cost Reporting projects for the State Government organization's clients. You ...

Oracle

Principal Consultant - Medicare

Kansas City, MO · On-site

As a Principal Consultant for Oracle Health, you will operate as the subject matter expert (SME) for Medicare and Medicare Cost Reporting projects for the State Government organization's clients. You ...

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Medicare Sme information

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How much do medicare sme jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for medicare sme in the United States is $22.42, according to ZipRecruiter salary data. Most workers in this role earn between $16.11 and $27.16 per hour, depending on experience, location, and employer.

What is a Medicare SME?

A Medicare SME, or Subject Matter Expert, is a professional with specialized knowledge and extensive experience in Medicare policies, regulations, and procedures. They provide guidance on compliance, help interpret complex Medicare rules, and support organizations in navigating the Medicare system. Medicare SMEs often work in healthcare organizations, insurance companies, or consulting firms to ensure adherence to federal guidelines and optimize Medicare-related operations.

What are the key skills and qualifications needed to thrive as a Medicare SME, and why are they important?

To thrive as a Medicare SME, you need in-depth knowledge of Medicare regulations, policies, and billing procedures, often supported by relevant healthcare certifications or experience in Medicare compliance. Familiarity with Medicare claims processing systems, CMS guidelines, and data analysis tools like Excel or healthcare software is crucial. Strong analytical thinking, attention to detail, and effective communication skills help you interpret complex regulatory information and advise stakeholders. These competencies ensure accurate guidance, regulatory compliance, and optimized Medicare operations in healthcare organizations.

What are some common challenges Medicare SMEs face when interpreting complex regulations and how can they stay updated with frequent changes?

Medicare Subject Matter Experts (SMEs) often encounter challenges in keeping up with frequently changing federal regulations and ensuring accurate interpretation for their teams. These complexities require strong attention to detail and proactive engagement with official updates from the Centers for Medicare & Medicaid Services (CMS). To stay current, SMEs typically participate in ongoing training, subscribe to regulatory newsletters, and collaborate with compliance and legal teams. Regularly attending webinars and industry conferences also helps SMEs maintain up-to-date knowledge and provide informed guidance within their organizations.

What is the difference between Medicare Sme vs Medicare Claims Specialist?

AspectMedicare SmeMedicare Claims Specialist
Required CredentialsKnowledge of Medicare policies, certifications like CMS certificationsSimilar certifications, often CMS certifications required
Work EnvironmentHealthcare organizations, insurance companies, consulting firmsHealthcare providers, insurance companies, billing departments
Employer & Industry UsageUsed in healthcare consulting, insurance, and compliance rolesCommon in medical billing, claims processing, and healthcare administration
Search & Comparison IntentUnderstanding role differences, job requirements, career pathsClarifying job responsibilities, qualifications, and work scope

The Medicare Sme typically provides expert advice on Medicare policies and compliance, often working in consulting or advisory roles. The Medicare Claims Specialist focuses on processing and managing Medicare claims within healthcare or insurance organizations. While both roles require knowledge of Medicare regulations and certifications, the Sme offers strategic guidance, whereas the Claims Specialist handles day-to-day claims processing tasks.

What are popular job titles related to Medicare Sme jobs?

For Medicare Sme jobs, the most frequently searched job titles are:

Infographic showing various Medicare Sme job openings in the United States as of September 2026, with employment types broken down into 1% Internship, 5% As Needed, 74% Full Time, 17% Part Time, and 3% Contract. Highlights an 84% Physical, 2% Hybrid, and 14% Remote job distribution, with an average salary of $46,633 per year, or $22.4 per hour.

Medicare Domain SME

Remote

Conflux Systems
IT Services • 11 - 50 employees
Learn more about Conflux Systemsexternal

Full-time

This job post has expired 4 days ago. Applications are no longer accepted.

Job description

Title: Medicare Domain SME
Location: Jefferson City MO, USA - Remote
MUST HAVE:
  • Medicare SME
  • Medicare Advantage
  • Enrolment
  • Premium Billing
  • CMS Guidelines
  • Capitation Revenue reconciliation
  • Member correspondence
  • Medicare operations workflow

This Expert must be able to play a leadership role in managing and coordinating the members of the BIA team. They must have excellent interpersonal skills, be self-reliant and generate confidence to the extent that they can take increasing levels of personal responsibility in relation to delivering solutions directly to the client. They will be required to undertake project management duties and lead work streams, participate in RFP responses, change request proposal development, provide product demonstration and Perform user acceptance testing.
Experience and Education Requirements
  • BA/BS degree in business/accounting/finance or equivalent experience.
  • Thorough experience of Medicare Advantage health plan operations around Eligibility and Enrolment, CMS guidelines, Member correspondence, Medicare operations workflow, Premium billing, and Capitation Revenue reconciliation
  • 10+ years' experience with customer relations activities, including business process management, issue management, ability to define desired outcomes, and solutions.
  • 10+ years' experience documenting requirements gathering sessions, processes, procedures, user manuals, and outcomes.
  • 10+ year experience developing test criteria and executing the test process.
  • Should have hands on experience writing basic SQL queries.
  • Excellent organizational skills and attention to detail, with the ability to multi-task and prioritize.

Apply