Senior Manager, Data Engineering – Medicare Revenue
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Job Description
Senior Manager owning CVS Health’s Medicare revenue data engineering foundation. Building auditable healthcare data pipelines for revenue forecasting, risk adjustment, Finance, and Actuarial teams.
Responsibilities:
- Own the data foundation supporting the Medicare revenue engine
- Design, build, and operate data pipelines and analytic tables for Medicare revenue projection models
- Ingest, normalize, and reconcile claims, encounters, eligibility/enrollment, EMR/chart extracts, vendor/program files, and CMS artifacts
- Implement HCC / ICD-10 mapping, model-year versioning, and diagnosis-year versus payment-year constructs
- Own data quality, reconciliation, lineage, and snapshot/freeze processes for accruals, AtoE, and audit
- Partner with enterprise data/IT on Databricks or equivalent lakehouse standards, Spark/PySpark, orchestration, CI/CD, access control, and cost/performance
- Provide documented datasets to Modeling, Finance, Actuarial, and Revenue Integrity
- Define freshness and completeness SLAs and monitor data drift and source-system changes
- Lead and mentor data engineers and establish engineering practices for a regulated, financially sensitive environment
- Support modular revenue, membership/mix, and related outputs
Requirements:
- 8+ years in data engineering
- 4+ years of expert-level experience in healthcare data, including claims, encounters, eligibility, provider, and clinical/chart sources
- 4+ years of hands-on production experience with Databricks / Spark (PySpark), Python, SQL, lakehouse / ELT patterns, orchestration such as Airflow or equivalent, and data-quality frameworks
- 4+ years of experience supporting risk-adjustment, actuarial, or finance workloads, including reconciliation, point-in-time history, and auditability
- Strong understanding of PHI, HIPAA, and controls appropriate to revenue and CMS-submission data
- Familiarity with 834/837, ICD-10, and HCC assignment
- SAS nice to have, especially for legacy actuarial extracts
- Direct RA file experience with MMR, MOR, MAO-004, and EDS/encounter status
- Prior work on member-level RA engines, suspect/recapture warehouses, or revenue-forecast data products
- Bachelor’s in CS, engineering, or related field, or equivalent experience
Benefits:
- CVS Health bonus, commission or short-term incentive program
- Equity award program
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
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