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Remote Risk Adjustment Provider Educator Jobs in Illinois

CNA

Risk Control Consultant, Virtual Center

Chicago, IL · On-site +1

$72K - $141K/yr

Individual contributor responsible for the overall risk control assessment, evaluation, consulting ... Develops and conducts remote education, training, and presentations. Provides expertise in one or ...

Varsity Tutors

Finance Tutor

Schaumburg, IL · Remote

$18 - $40/hr

... risk adjustment in valuation, and interpreting financial ratios. Adapts instruction using financial ... Ways To Connect With Students * 1-on-1 Online Tutoring - Provide personalized instruction to ...

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Finance Tutor

Evanston, IL · Remote

$18 - $40/hr

... risk adjustment in valuation, and interpreting financial ratios. Adapts instruction using financial ... Ways To Connect With Students * 1-on-1 Online Tutoring - Provide personalized instruction to ...

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Finance Tutor

Buffalo Grove, IL · Remote

$18 - $40/hr

... risk adjustment in valuation, and interpreting financial ratios. Adapts instruction using financial ... Ways To Connect With Students * 1-on-1 Online Tutoring - Provide personalized instruction to ...

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Finance Tutor

Oak Lawn, IL · Remote

$18 - $40/hr

... risk adjustment in valuation, and interpreting financial ratios. Adapts instruction using financial ... Ways To Connect With Students * 1-on-1 Online Tutoring - Provide personalized instruction to ...

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Finance Tutor

Highland Park, IL · Remote

$18 - $40/hr

... risk adjustment in valuation, and interpreting financial ratios. Adapts instruction using financial ... Ways To Connect With Students * 1-on-1 Online Tutoring - Provide personalized instruction to ...

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Finance Tutor

Normal, IL · Remote

$18 - $40/hr

... risk adjustment in valuation, and interpreting financial ratios. Adapts instruction using financial ... Ways To Connect With Students * 1-on-1 Online Tutoring - Provide personalized instruction to ...

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Finance Tutor

Lake Forest, IL · Remote

$18 - $40/hr

... risk adjustment in valuation, and interpreting financial ratios. Adapts instruction using financial ... Ways To Connect With Students * 1-on-1 Online Tutoring - Provide personalized instruction to ...

Varsity Tutors

Finance Tutor

Wheaton, IL · Remote

$18 - $40/hr

... risk adjustment in valuation, and interpreting financial ratios. Adapts instruction using financial ... Ways To Connect With Students * 1-on-1 Online Tutoring - Provide personalized instruction to ...

Varsity Tutors

Finance Tutor

Champaign, IL · Remote

$18 - $40/hr

... risk adjustment in valuation, and interpreting financial ratios. Adapts instruction using financial ... Ways To Connect With Students * 1-on-1 Online Tutoring - Provide personalized instruction to ...

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Remote Risk Adjustment Provider Educator information

What is the difference between Remote Risk Adjustment Provider Educator vs Remote Risk Adjustment Analyst?

AspectRemote Risk Adjustment Provider EducatorRemote Risk Adjustment Analyst
CredentialsCertifications in risk adjustment, healthcare coding, or related fieldsCertifications in data analysis, healthcare analytics, or coding
Work EnvironmentRemote, educational, training-focusedRemote, data analysis, reporting
Employer & IndustryHealth plans, healthcare providers, education companiesHealth plans, analytics firms, healthcare organizations

The Remote Risk Adjustment Provider Educator primarily focuses on training healthcare providers and staff on risk adjustment processes, requiring educational skills and certifications. In contrast, the Remote Risk Adjustment Analyst analyzes data to identify trends and improve risk scores. Both roles are remote and industry-specific but differ in their core functions and skill sets.

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Remote Risk Adjustment Provider Educator jobs near you

CMS EDGE Server / Risk Adjustment Data Architect

Huron Consulting Group

Chicago, IL • On-site, Remote

$65.75 - $84.50/hr

Full-time

Posted 26 days ago

Huron Consulting Group rating

7.2

Company rating: 7.2 out of 10

Based on 7 frontline employees who took The Breakroom Quiz

55th of 73 rated business consultants

Job description

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 / Risk Adjustment Data Architect to serve as a strategic technical advisor and hands-on architecture lead for healthcare payer clients. This individual will bring deep expertise in CMS EDGE Server operations, ACA risk adjustment, reinsurance, payer data platforms, and regulatory reporting architecture. The ideal candidate will design and guide scalable, compliant CMS EDGE Server solutions that support accurate submission of membership, claims, encounter, supplemental diagnosis, and other CMS-facing data while partnering closely with business, compliance, actuarial, operations, and technology stakeholders.
W2 Hourly (No H1B)
Start: August 2026
Duration: 6 mths, with possible extension
Key Responsibilities
  • Serve as the - CMS EDGE Server / Risk Adjustment Data Architect and subject matter expert for ACA risk adjustment, reinsurance, and CMS regulatory reporting initiatives.
  • Design and oversee end-to-end CMS EDGE Server architecture, including source system integration, data ingestion, transformation, validation, reconciliation, submission readiness, and error resolution processes.
  • Lead CMS EDGE Server implementations, upgrades, enhancements, production support, and operational stabilization efforts for payer clients.
  • Translate CMS/HHS reporting requirements, business rules, and regulatory updates into scalable technical designs, solution roadmaps, data specifications, and implementation plans.
  • Partner with payer business, actuarial, risk adjustment, compliance, data engineering, IT, and vendor teams to align CMS EDGE Server capabilities with operational and regulatory objectives.
  • Define and improve data quality controls across membership, eligibility, claims, encounter, provider, and supplemental diagnosis data to support accurate and audit-ready CMS submissions.
  • Perform root-cause analysis on submission errors, data defects, reconciliation gaps, and downstream reporting issues; recommend and guide remediation strategies.
  • Develop architecture documentation, data flow diagrams, business and technical requirements, user stories, acceptance criteria, and operational playbooks for CMS EDGE Server processes.
  • Provide client-facing advisory support on CMS EDGE Server best practices, implementation risks, reporting timelines, data governance, and production readiness.

Required Qualifications
  • 7+ years of healthcare payer experience with strong exposure to ACA, risk adjustment, reinsurance, regulatory reporting, and payer data operations.
  • Deep hands-on experience with CMS EDGE Server architecture, implementation, operations, configuration, data submission workflows, and production support.
  • Strong understanding of CMS/HHS requirements, ACA EDGE Server reporting, risk adjustment transfer payment processes, reinsurance reporting, and regulatory submission timelines.
  • Experience designing or supporting data pipelines and interfaces across payer source systems, claims platforms, encounter processing, membership/eligibility systems, and CMS-facing reporting environments.
  • Proven ability to define technical architecture, data mapping, validation rules, reconciliation logic, exception reporting, and operational controls for CMS EDGE Server submissions.
  • Experience working directly with health plan stakeholders, technology teams, vendors, and compliance partners in client-facing advisory or consulting environments.
  • Strong documentation, communication, facilitation, and executive stakeholder management skills, with the ability to explain technical issues to business and compliance audiences.

Preferred Qualifications
  • Experience with Cognizant CMS EDGE Server, ClaimSphere, Facets (TriZetto), HealthRules, QNXT, or other payer core administration and reporting platforms.
  • Experience with SQL, data analysis, data profiling, ETL/ELT concepts, data lineage, exception reporting, and healthcare data quality management.
  • Knowledge of Medicare Advantage, Medicaid, commercial exchange, HEDIS, CMS STARs, encounter data, risk adjustment analytics, or quality reporting programs.
  • Experience creating product roadmaps, solution designs, implementation plans, user stories, test plans, operational readiness materials, and governance reporting.
  • Familiarity with Agile delivery, Jira, Azure DevOps, Confluence, Power BI, Visio, Lucidchart, or similar tools used to manage complex payer technology initiatives.

#LI-DT1
#LI-Remote
Position Level
Consultant
Country
United States of America

What Huron Consulting Group employees say

Pay

Hours and flexibility

Workplace

Get the full story on Breakroom

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About Huron Consulting Group

Sourced by ZipRecruiter

Huron Consulting Group, based in Chicago, IL, US, is a leading global management consulting firm specialized in providing performance improvement and reformation skills to different types of organizations. The company operates in the management consulting industry, which includes strategy, operations, technology, and analytics. Founded in 2002, Huron Consulting Group aids entities to tackle complex business challenges, enhance their ability to drive change, encourage their efficiency, and stimulate innovation. The company's overriding mission is to assist clients in becoming more successful.

Industry

Business management consulting

Company size

1,001 - 5,000 Employees

Headquarters location

Chicago, IL, US

Year founded

2002

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