CMS EDGE Server / Risk Adjustment Data Architect

Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes.

Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients.

Joining the Huron team means you’ll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise.

Join our team as the expert you are now and create your future.

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.
• Translate business requirements into product, process, and technical solutions.
• Provide strategic advisory support to health plan clients on CMS reporting best practices.

Required Qualifications

• 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.

Preferred Qualifications

• 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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