The Implementation Architect is responsible for architecting and delivering complex client implementations within Veradigm's Payer Analytics and Risk Adjustment product suite, including Risk Adjustment Analytics, Quality Analytics, Risk Mitigator, eChart Integration and Analytics, Veradigm Coding Technology, and Provider Engagement Solutions. This role serves as the primary technical authority across the full implementation lifecycle, translating health plan and at-risk provider business requirements into scalable solution designs, guiding cross-functional delivery teams, and acting as a trusted advisor to clients and internal stakeholders.

The Implementation Architect operates with a high degree of independence, resolves highly complex and ambiguous implementation challenges, and is recognized as a subject matter expert in risk adjustment, quality analytics, and health plan data integration. Deep, hands-on experience with Medicaid, Medicare (including Medicare Advantage), and Affordable Care Act (ACA) marketplace lines of business is critical to this role, as clients' risk adjustment and quality models, submission requirements, and regulatory obligations vary significantly across these programs.

Working Arrangements:

• Standard work week or as defined by assignment requirements.
• Primarily works in a standard office environment or remotely.
• May require after-hours, on-call support and/or holidays.
• On-call and after-hours work during peak times including end of month/quarter/year; during this time PTO is limited to meet business needs.

Travel:
Up to 50% travel may be required.

What You'll Contribute:

• Lead end-to-end solution architecture and technical design for enterprise-level implementations of Veradigm Payer Analytics and Risk Adjustment solutions, including Risk Adjustment Analytics, Quality Analytics, Risk Mitigator (RADV audit support), and RA submission workflows, across Medicaid, Medicare, and ACA lines of business.
• Partner directly with health plan and at-risk provider clients to gather, validate, and translate complex business, regulatory, and data requirements (HEDIS, Star Ratings, QRS, PQA, RADV) into detailed technical implementation plans, accounting for program-specific rules across Medicaid, Medicare Advantage, and ACA marketplace risk adjustment models.
• Advise clients on the distinct risk adjustment methodologies, submission timelines, and data requirements associated with CMS-HCC (Medicare), state-specific Medicaid risk adjustment models (e.g., CDPS, state-specific HHS-HCC variants), and the HHS-HCC model used for ACA marketplace plans, ensuring implementations are configured to each program's requirements.
• Design and oversee data integration strategies across client source systems, EHRs, and the Veradigm Network, leveraging HL7 FHIR, CCDA, EDI, and eChart Integration and Analytics to ensure accurate, secure, and timely data exchange.
• Architect client data onboarding strategies, evaluating client source systems and data structures to define the optimal path for onboarding claims, eligibility, provider, clinical, encounter, and supplemental healthcare data into Veradigm Payer Analytics and Risk Adjustment solutions.
• Design data mappings, transformation requirements, and integration approaches across client and third-party data sources, ensuring implementation designs are scalable, reusable, and repeatable across engagements and lines of business.
• Own the design of data quality frameworks, including data validation, reconciliation, and exception-handling processes that confirm completeness, accuracy, and regulatory compliance of client data.
• Lead root cause analysis of data issues identified during onboarding, configuration, and validation, and drive remediation with client and internal teams to ensure data is analytics-ready for quality reporting, risk adjustment, and submission workflows.
• Architect configuration of Quality and Risk Adjustment analytics engines, coding workflows (including Veradigm Coding Technology's CAC, NLP, and OCR capabilities), and Provider Engagement Solutions to meet client-specific quality and risk scoring objectives.
• Serve as the escalation point and technical authority for complex, ambiguous, or high-risk implementation issues, driving them to resolution across internal engineering, product, and client teams.
• Provide project teams and client stakeholders with implementation roadmaps, risk assessments, and mitigation strategies to ensure on-time, on-budget, and high-quality go-lives.
• Mentor and provide technical guidance to other Implementation Architects and Consultants, sharing best practices and reusable implementation frameworks across engagements.
• Collaborate with Product Management and Engineering to influence roadmap decisions based on field implementation experience, client feedback, and observed data or integration gaps.
• Partner closely with Product, Engineering, and Data teams to review implementation approaches and technical designs, support solution design activities, and participate in testing strategy discussions for client implementations.
• Evaluate implementation tradeoffs and technical risks, and provide implementation guidance throughout the development lifecycle to ensure delivered solutions meet client, regulatory, and performance requirements.
• Develop and maintain implementation documentation, configuration standards, and reusable assets that improve delivery consistency and quality across the Payer Analytics and Risk Adjustment portfolio.
• Support pre-sales and scoping activities as needed, providing technical input on solution feasibility, level of effort, and implementation approach for prospective clients.

Required Qualifications:

• Bachelor's degree or equivalent technical/business experience required
• 10+ years relevant work experience; if internal, 2-3 years at the Expert level preferred
• Deep functional and technical expertise in health plan risk adjustment (CMS-HCC, HHS-HCC) and quality analytics (HEDIS, Star Ratings, QRS, PQA) methodologies and regulatory requirements.
• Critical, demonstrated experience working with Medicaid, Medicare (including Medicare Advantage), and ACA marketplace lines of business, including their distinct risk adjustment models, quality reporting requirements, and regulatory submission cycles.
• Advanced knowledge of healthcare data standards and integration methods, including HL7 FHIR, CCDA, EDI transactions, and clinical data exchange across EHR platforms.
• Proven ability to architect complex, scalable technical solutions and lead their implementation across multiple concurrent, high-visibility client engagements.
• Advanced SQL and database expertise, including the ability to analyze complex healthcare datasets, validate transformation logic, troubleshoot implementation challenges, perform root cause analysis, and guide technical teams on data architecture best practices.
• Extensive hands-on experience working with healthcare claims, eligibility, provider, encounter, clinical, and supplemental data sets, and how each is used within payer analytics, quality measurement, and risk adjustment programs.
• Experience designing or overseeing ETL/ELT processes and healthcare data pipeline architecture, including enterprise-scale data integration frameworks supporting large-scale healthcare data onboarding initiatives.
• Excellent client-facing communication and consulting skills, with the ability to advise executive-level health plan and provider stakeholders.
• Demonstrated project and program leadership skills, including risk management, prioritization, and cross-functional team coordination.
• Ability to operate independently in ambiguous, high-complexity situations and serve as a subject matter expert and resource to others across the organization.
• Experience mentoring and developing junior implementation staff and contributing to organizational best practices and standards.

Preferred Qualifications:

• Working knowledge of Azure cloud data technologies, including Azure Data Factory, Azure SQL, Azure Synapse, Azure Data Lake, and Databricks, sufficient to partner effectively with engineering teams rather than perform hands-on development.
• Understanding of data warehousing concepts and dimensional modeling as applied to healthcare analytics platforms.
• Familiarity with healthcare interoperability standards and their use in client data exchange.
• Prior experience leading client-facing healthcare implementations for health plans or at-risk provider organizations.
• Familiarity with Agile methodologies, DevOps processes, release management, Software Development Lifecycle (SDLC) practices, and version control concepts.
• Agile / Scrum experience supporting iterative delivery of analytics and reporting solutions.
• Experience with value-based care, risk adjustment, and quality analytics programs across Medicaid, Medicare, and ACA lines of business.

Compensation Range:

Compensation for this job is subject to market conditions, geographic considerations, the candidate’s unique skills and experience, state and local laws, and budget. Our commitment to pay transparency is a testament to our dedication to creating a fair, equitable, and inclusive workplace. By continuously analyzing market trends, staying abreast of changes in state laws, and making budgetary adjustments accordingly, we strive to ensure that our compensation practices reflect the value we place on our associates’ unique contributions and support their professional growth.

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Visa Sponsorship is not offered for this position.

At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve. The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.

Veradigm’s policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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