Overview
The Senior Business Analyst - Medicare Claims & Appeals Programs supports the CMS Medicare Appeals System (MAS) by leading business case development, requirements analysis, and stakeholder engagement within an agile delivery environment.
At TISTA, you'll do meaningful, missiondriven work that improves lives alongside teammates you trust and leaders who are transparent and supportive. We invest in your learning and internal mobility so you can build a career that keeps advancing. We're proud to serve and hire Veterans, and we put people first in everything we do. TISTA associates enjoy above Industry Healthcare Benefits, Remote Working Options, Paid Time Off, Training/Certification opportunities, Healthcare Savings Account & Flexible Savings Account, Paid Life Insurance, Short-term & Long-term Disability, 401K Match, Professional development reimbursement, Employee Assistance Program, Paid Holidays, Military Leave, and much more!
Responsibilities
-
Apply Medicare claims and appeals domain knowledge to ensure business requirements align with operational and regulatory requirements. -
Perform business case development and detailed requirements analysis. - Develop and maintain use cases, user stories, and supporting documentation.
- Lead requirements gathering and facilitation sessions to ensure requirements are accurate, complete, and clearly defined.
- Communicate requirements effectively to other analysts and development teams.
- Collaborate with agile teams and participate in agile ceremonies (e.g., backlog refinement, sprint planning, reviews).
- Demonstrate product functionality to stakeholders to validate requirements and confirm expected outcomes.
- Support functional specification development, storyboarding, and use case diagramming.
- Serve as a key liaison between business stakeholders and technical teams throughout the system development lifecycle.
Qualifications
Required Qualifications:
- Experience performing business case development and detailed requirements analysis.
- Demonstrated experience supporting Medicare claims operations, including claims intake, adjudication, or downstream workflows.
- Experience developing use cases, user stories, and functional documentation.
- Ability to clearly define and articulate requirements to technical and nontechnical audiences.
- Experience working within agile frameworks.
- Strong verbal and written communication skills.
Strongly Preferred Qualifications:
- Experience supporting Medicare appeals programs, including pre and postadjudication processes.
- Five (5) or more years of experience supporting Medicare claims and/or appeals programs.
- Ten (10) or more years of overall experience in business analysis, including requirements facilitation, storyboarding, functional specification development, and use case diagramming.
- Experience facilitating requirements sessions with business, technical, and operational stakeholders.
- Prior experience supporting CMSaligned or federal health programs.
Nice to Have:
- Experience with CMS systems or Medicare Advantage platforms.
- Experience supporting audits, compliance initiatives, or regulatory reporting.
- Scrum Master Certification (preferred).
Location:
- Hybrid - CMS and contractor sites.
- Preference for DC / Baltimore / DMV area.
Clearance:
- Must be a U.S. Citizen
- Must be able to obtain and maintain a CMS Public Trust clearance.
Pay Range:
- The pay for this position ranges from $120,000 to $140,000.
- The actual salary offer will carefully consider a wide range of factors, including your skills, qualifications, experience, and location.
- Also, certain positions are eligible for additional forms of compensation, such as bonuses.
- TISTA associates are eligible to participate in our comprehensive benefits plan! More information can be found here: https://tistatech.com/working-at-tista/
|
TISTA Science and Technology Corporation
life insurance, paid time off, paid holidays, 401(k)
Apr 22, 2026