CMS EDGE Server Product Manager / Principal / Architect
Temporary
Huron
Role Description
We are seeking an experienced CMS EDGE Server Product Manager / Principal / Architect to serve as a strategic advisor and subject matter expert supporting healthcare payer clients. This individual will bring deep expertise in CMS EDGE Server operations, risk adjustment, reinsurance reporting, and payer platforms to help clients ensure accurate and compliant submission of membership, claims, and encounter data to CMS. The ideal candidate combines strong business knowledge of ACA, Medicare, and Medicaid regulatory programs with hands-on implementation and product leadership experience.
- 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.
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.
Requirements
- W2 Hourly (No H1B).
- Start: August 2026.
- Duration: 6 mths, with possible extension.
Position Level
- Consultant.
Country
- United States of America.
Vacancy posted 4 days ago
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