CMS EDGE Server / Risk Adjustment Data Architect

Huron
Chicago
Workplace: RemoteContractFunction: Product ManagementExperience: 7+ yearsSkills: ["Communication","Stakeholder management","Problem solving","Requirements translation"]

Serve as a subject matter expert for CMS EDGE Server and ACA Risk Adjustment, partnering with healthcare payer clients to ensure accurate and compliant submission of membership, claims, encounter, and supplemental data to CMS. Lead CMS EDGE Server implementations, enhancements, and operational support, while driving data validation, reconciliation, and reporting quality improvements. Translate business requirements into product, process, and technical solutions and provide strategic advisory on CMS reporting best practices.

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FursaFursa
Huron
Huron
2 months ago

CMS EDGE Server / Risk Adjustment Data Architect

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Source: Company careers pageValidated by: Fursa AI
Last checked: 24 days agoStatus: Live

Job Summary

Serve as a subject matter expert for CMS EDGE Server and ACA Risk Adjustment, partnering with healthcare payer clients to ensure accurate and compliant submission of membership, claims, encounter, and supplemental data to CMS. Lead CMS EDGE Server implementations, enhancements, and operational support, while driving data validation, reconciliation, and reporting quality improvements. Translate business requirements into product, process, and technical solutions and provide strategic advisory on CMS reporting best practices.
Location: Chicago
Workplace: Remote
Employment Type: Contract · 6 months
Job Function: Product Management
Seniority: Sr. Manager level

Key Responsibilities

  • •Serve as SME for CMS EDGE Server, ACA Risk Adjustment, and reinsurance programs.
  • •Lead CMS EDGE Server implementations, enhancements, and operational support initiatives.
  • •Ensure accurate and compliant submission of membership, claims, encounter, and supplemental data to CMS.
  • •Drive data validation, reconciliation, and reporting quality improvements.
  • •Partner with business, operational, compliance, and technical teams to resolve data and reporting issues.

Key Requirements

  • •7+ years of healthcare payer experience.
  • •Deep expertise with CMS EDGE Server and ACA Risk Adjustment.
  • •Strong understanding of reinsurance, risk adjustment, and regulatory reporting requirements.
  • •Experience with health plan membership, claims, and encounter data.
  • •Proven implementation and client-facing consulting experience.
Experience:7+ yearsHealthcare payerHealthcareRegulatory reportingACAMedicareMedicaid
Skills:CommunicationStakeholder managementProblem solvingRequirements translation
Tech Stack:CMS EDGE ServerSQLFacets (TriZetto)Cognizant CMS EDGE ServerClaimSphere

Eligibility

Work Authorization:Authorization required. Sponsorship not provided.

Company Brief

Huron
Huron is a global professional services firm providing consulting and advisory services across healthcare, higher education, life sciences, and commercial sectors, focusing on strategy, operations, technology, and financial transformation.
Industry: Consulting
Company Size: Enterprise (1,001+ employees)
Growth: Established Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: Chicago, United States
Founded: 2002
Glassdoor
Glassdoor: 3.8
WebsiteLinkedIn