Senior Healthcare Data Integration Engineer

We are seeking a Senior Healthcare Data Integration Engineer to work on the Exchange Encounter & Risk Adjustment team. This person will support healthcare payer operations focused on ACA Exchange Risk Adjustment, CMS EDGE submissions, encounter data quality, and healthcare data integration. This is a hands-on technical leadership role responsible for troubleshooting complex healthcare data issues, improving encounter data quality, supporting CMS EDGE processes, and partnering across business, IT, data, and vendor teams. This is not a project management role.

• Lead technical troubleshooting of encounter and risk adjustment data issues

• Analyze CMS EDGE submission errors and drive resolution

• Support encounter reconciliation, validation, and error remediation activities

• Partner with business, operations, data, IT, and vendor teams

• Improve encounter acceptance rates and overall data quality

Strong experience with SSIS, ETL, and C#

-Healthcare background, specifically with CMS/Medicare/Medicaid

-Strong understanding of healthcare payer data, including:

o Claims

o Encounters

o Enrollment

o Diagnosis data

• Advanced SQL skills for data analysis, validation, and troubleshooting

• Experience with healthcare EDI transactions

• Experience with healthcare integration platforms such as:

o Edifecs

o IBM ITX (Transformation Extender)

o Similar healthcare EDI/integration tools

• Proven ability to troubleshoot complex healthcare data pipelines and submission issues * HHS-HCC Risk Adjustment experience

• Direct experience supporting ACA Exchange Risk

Adjustment

• Hands-on experience with CMS EDGE Server

submissions, reconciliation, validation, and error remediation

• Encounter acceptance/rejection analysis

• CMS audit support

• Data quality improvement initiatives

• Healthcare data warehouse or data lake environments

• Databricks or cloud-based healthcare data platforms

• Technical leadership or mentoring experience

• Vendor management experience