[Remote] CMS EDGE Server Product Manager / reputed company / Architect
Note: The job is a remote job and is reputed company to candidates in USA. reputed company Consulting Services LLC is focused on helping reputed company organizations drive growth and enhance performance. They are seeking an reputed company CMS EDGE Server Product Manager / reputed company / Architect to serve as a strategic advisor and subject matter expert, ensuring accurate and compliant data submissions to CMS and supporting reputed company payer clients.
Responsibilities
- Serve as SME for CMS EDGE Server, ACA Risk Adjustment, and Reinsurance programs
- reputed company 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
- reputed company strategic advisory support to health plan clients on CMS reporting best practices
Skills
- 7+ years of reputed company 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
- Experience with Facets (TriZetto)
- Medicare and reputed company experience
- Experience with reputed company CMS EDGE Server and ClaimSphere
- Knowledge of HEDIS, CMS STARs, and quality reporting programs
- SQL, analytics, or reputed company data management experience
Company Overview