CMS EDGE Server Product Manager / Principal / Architect
Core
Strategic advisor and subject matter expert supporting healthcare payer clients on CMS EDGE Server operations, risk adjustment, and reinsurance reporting to ensure accurate and compliant data submission to CMS.
Role type
Consultant-level CMS EDGE Server Product Manager / Principal / Architect
Builds
Compliant membership, claims, and encounter data submissions to CMS
Domain
Healthcare Payer Services / Regulatory Reporting
Deliverable
client delivery
Required skills
CMS EDGE Server operations, ACA Risk Adjustment, Reinsurance reporting, health plan data management, regulatory compliance, implementation consulting, data validation and reconciliation
Preferred skills
Facets (TriZetto), Cognizant ClaimSphere, Medicare/Medicaid programs, HEDIS, SQL
Responsibilities
Serve as SME for CMS EDGE Server and ACA Risk Adjustment programs; Lead CMS EDGE Server implementations and operational support; Ensure accurate and compliant data submission to CMS; Drive data validation and reporting quality improvements; Partner with business and technical teams to resolve data issues; Translate business requirements into technical solutions; Provide strategic advisory support on CMS reporting best practices