CMS EDGE Server 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 youll 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 the CMS EDGE Server 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 processes.
• Lead CMS EDGE Server implementations upgrades enhancements production support and operational stabilization efforts for payer clients.
• Translate CMS/HHS reporting requirements business rules and regulatory updates into scalable technical designs solution roadmaps data specifications and implementation plans.
• Partner with payer business actuarial risk adjustment compliance data engineering IT and vendor teams to align CMS EDGE Server capabilities with operational and regulatory objectives.
• Define and improve data quality controls across membership eligibility claims encounter provider and supplemental diagnosis data to support accurate and audit-ready CMS submissions.
• Perform root-cause analysis on submission errors data defects reconciliation gaps and downstream reporting issues; recommend and guide remediation strategies.
• Develop architecture documentation data flow diagrams business and technical requirements user stories acceptance criteria and operational playbooks for CMS EDGE Server processes.
• Provide client-facing advisory support on CMS EDGE Server best practices implementation risks reporting timelines data governance and production readiness.

Required Qualifications

• 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 the ability to explain technical issues to business and compliance audiences.

Preferred Qualifications

• Experience with Cognizant CMS EDGE Server ClaimSphere Facets (TriZetto) HealthRules QNXT or other payer core administration and reporting platforms.
• Experience with SQL data analysis data profiling ETL/ELT concepts data lineage exception reporting and healthcare data quality management.
• Knowledge of Medicare Advantage Medicaid commercial exchange HEDIS CMS STARs encounter data risk adjustment analytics or quality reporting programs.
• Experience creating product roadmaps solution designs implementation plans user stories test plans operational readiness materials and governance reporting.
• Familiarity with Agile delivery Jira Azure DevOps Confluence Power BI Visio Lucidchart or similar tools used to manage complex payer technology initiatives.

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