Note: The job is a remote job and is open to candidates in USA. Huron is a consulting firm that helps healthcare organizations drive growth and enhance performance. They are seeking an experienced CMS EDGE Server Product Manager / Principal / Architect to provide strategic advisory support and expertise in CMS EDGE Server operations and regulatory reporting for healthcare payer clients.
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
- Translate business requirements into product, process, and technical solutions
- Provide strategic advisory support to health plan clients on CMS reporting best practices
Skills
- 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
- Strong knowledge of payer operations and data quality processes
- Excellent communication and stakeholder management skills
- Experience with Facets (TriZetto)
- Medicare and Medicaid experience
- Experience with Cognizant CMS EDGE Server and ClaimSphere
- Knowledge of HEDIS, CMS STARs, and quality reporting programs
- SQL, analytics, or healthcare data management experience
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