Risk Adjustment Data Architect, CMS Edge Server

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $70 - $90 / hour

⏰ Full Time

🟠 Senior

🔴 Lead

🚰 Data Engineer

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Huron

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 2002

🏥 Healthcare

📦 Logistics

📣 Marketing

Healthcare • Logistics • Marketing

Huron Consulting Group is a global consultancy that provides a wide range of services including strategy, operations, advisory, digital, technology, and analytics solutions to various sectors such as healthcare, education, energy, and financial services. Huron helps organizations navigate complex challenges and drive growth through tailored solutions and innovative strategies. The company employs a team of experts dedicated to delivering high-impact solutions that address the unique needs of each client, focusing on areas such as managed services, outsourcing, and leadership development.

📋 Description

• Serve as the CMS EDGE Server / Risk Adjustment Data Architect and subject matter expert for ACA risk adjustment, reinsurance, and CMS regulatory reporting initiatives • Design and oversee end-to-end CMS EDGE Server architecture, including source system integration, data ingestion, transformation, validation, reconciliation, submission readiness, and error resolution • Lead CMS EDGE Server implementations, upgrades, enhancements, production support, and operational stabilization for payer clients • Translate CMS/HHS reporting requirements, business rules, and regulatory updates into technical designs, solution roadmaps, data specifications, and implementation plans • Partner with payer business, actuarial, risk adjustment, compliance, data engineering, IT, and vendor teams • Define and improve data quality controls across membership, eligibility, claims, encounter, provider, and supplemental diagnosis data • Perform root-cause analysis on submission errors, data defects, reconciliation gaps, and downstream reporting issues; guide remediation strategies • Develop architecture documentation, data flow diagrams, business and technical requirements, user stories, acceptance criteria, and operational playbooks • Provide client-facing advisory support on CMS EDGE Server best practices, implementation risks, reporting timelines, data governance, and production readiness

🎯 Requirements

• 7+ years of healthcare payer experience with strong exposure to ACA, risk adjustment, reinsurance, regulatory reporting, and payer data operations • Deep hands-on experience with CMS EDGE Server architecture, implementation, operations, configuration, data submission workflows, and production support • Strong understanding of CMS/HHS requirements, ACA EDGE Server reporting, risk adjustment transfer payment processes, reinsurance reporting, and regulatory submission timelines • Experience designing or supporting data pipelines and interfaces across payer source systems, claims platforms, encounter processing, membership/eligibility systems, and CMS-facing reporting environments • Proven ability to define technical architecture, data mapping, validation rules, reconciliation logic, exception reporting, and operational controls for CMS EDGE Server submissions • Experience working directly with health plan stakeholders, technology teams, vendors, and compliance partners in client-facing advisory or consulting environments • Strong documentation, communication, facilitation, and executive stakeholder management skills, with ability to explain technical issues to business and compliance audiences • Preferred: Experience with Cognizant CMS EDGE Server, ClaimSphere, Facets (TriZetto), HealthRules, QNXT, or other payer core administration and reporting platforms • Preferred: Experience with SQL, data analysis, data profiling, ETL/ELT concepts, data lineage, exception reporting, and healthcare data quality management • Preferred: Knowledge of Medicare Advantage, Medicaid, commercial exchange, HEDIS, CMS STARs, encounter data, risk adjustment analytics, or quality reporting programs • Preferred: Experience creating product roadmaps, solution designs, implementation plans, user stories, test plans, operational readiness materials, and governance reporting • Preferred: Familiarity with Agile delivery, Jira, Azure DevOps, Confluence, Power BI, Visio, Lucidchart, or similar tools • Must be a U.S. Citizen • H-1B, C2C, and 1099 candidates are not considered

🏖️ Benefits

• Medical, dental, and vision coverage for employees and dependents • 401(k) plan with a generous employer match • Employee stock purchase plan • Generous Paid Time Off policy • Paid parental leave • Adoption assistance • Wellness Program with free annual health screenings and coaching • Bank at work • On-site workshops • Ongoing programs recognizing major employee life events