CMS EDGE Server Product Manager – Principal – Architect

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Act as the Subject Matter Expert (SME) for CMS EDGE Server, ACA Risk Adjustment, and Reinsurance programs.

• Oversee the implementation, enhancement, and operational support initiatives for CMS EDGE Server.

• Ensure the accurate and compliant submission of membership, claims, encounter, and supplemental data to CMS.

• Lead efforts in data validation, reconciliation, and the enhancement of reporting quality.

• Collaborate with business, operational, compliance, and technical teams to address data and reporting challenges.

• Convert business requirements into effective product, process, and technical solutions.

• Offer strategic advisory support to health plan clients regarding best practices for CMS reporting.

⛳️ Requirements

• Minimum of 7 years of experience in healthcare payer roles.

• Extensive knowledge of CMS EDGE Server and ACA Risk Adjustment.

• Strong comprehension of Reinsurance, Risk Adjustment, and regulatory reporting standards.

• Familiarity with health plan membership, claims, and encounter data.

• Demonstrated experience in implementation and client-facing consulting.

• In-depth understanding of payer operations and data quality protocols.

• Exceptional communication and stakeholder management abilities.

🏝️ Benefits

• Comprehensive medical, dental, and vision coverage for employees and their dependents.

• A 401(k) plan featuring a substantial employer matching contribution.

• An employee stock purchase program.

• A generous Paid Time Off policy.

• Paid parental leave and assistance for adoption.

• A Wellness Program that promotes employee well-being through free annual health screenings and coaching, banking at work, on-site workshops, and ongoing recognition of significant life events throughout the year.