CMS EDGE Server Product Manager / Principal / Architect

Huron • Chicago, IL

3d • Remote

About The Position

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. Huron helps healthcare organizations drive growth, enhance performance, and sustain leadership in an increasingly complex healthcare environment. Within our HDTx Payer Services practice, we partner with health plans to modernize operations, optimize regulatory reporting, improve data quality, and enable data-driven decision making. 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.

Requirements

• 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.

Nice To Haves

• 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.

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.

Benefits

• medical, dental, and vision coverage to employees and dependents
• a 401(k) plan with a generous employer match
• an employee stock purchase plan
• a generous Paid Time Off policy
• paid parental leave and adoption assistance
• Wellness Program supports employee total well-being by providing free annual health screenings and coaching, bank at work, and on-site workshops, as well as ongoing programs recognizing major events in the lives of our employees throughout the year.

What This Job Offers

• Job Type: Full-time
• Career Level: Principal
• Education Level: No Education Listed