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CVS Health is an American healthcare company working across healthcare services, health insurance, pharmacy benefits management, and retail pharmacy. Through businesses including Aetna and CVS Caremark, it supports health coverage, prescription access, condition management, specialty medications, and mail-order pharmacy services. Its neighborhood pharmacies and broader care offerings are designed to help people access essential healthcare more conveniently and affordably. CVS Health brings together insurance, pharmacy, and health services to support individuals and communities throughout their care journeys.
Senior Manager, Medicare Revenue Data Engineering - Remote
Lead CVS Health’s data engineering foundation for Medicare revenue. Build auditable healthcare data pipelines supporting forecasting, risk adjustment, Finance, and Actuarial teams.
United States
Alabama
Arizona
California
Colorado
Connecticut
Florida
Illinois
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Wisconsin
Wyoming$82,940 – $182,549 / year
RemoteFull-timeSeniorEnglish RequiredData EngineerDescription
- Own the data foundation that powers the Medicare revenue engine
- Design, build, and operate pipelines and analytical tables for Medicare revenue projection models
- Ingest, standardize, and reconcile claims, encounters, eligibility and enrollment, EMR and chart extracts, vendor and program files, and CMS artifacts
- Implement HCC and ICD-10 mappings, model-year versioning, and diagnosis-year versus payment-year structures
- Manage data quality, reconciliation, lineage, and snapshot or freeze processes for accruals, AtoE, and audit requirements
- Partner with enterprise data and IT teams on Databricks or comparable lakehouse standards, Spark and PySpark, orchestration, CI/CD, access controls, and cost and performance optimization
- Deliver documented datasets to Modeling, Finance, Actuarial, and Revenue Integrity teams
- Establish freshness and completeness SLAs while monitoring data drift and source-system changes
- Lead and mentor data engineers and define engineering practices for a regulated, financially sensitive environment
- Support modular revenue, membership and mix, and related data outputs
Requirements
- At least 8 years of experience in data engineering
- At least 4 years of expert-level experience working with healthcare data, including claims, encounters, eligibility, provider, and clinical or chart sources
- At least 4 years of hands-on production experience with Databricks or Spark with PySpark, Python, SQL, lakehouse or ELT patterns, Airflow or comparable orchestration, and data-quality frameworks
- At least 4 years supporting risk-adjustment, actuarial, or finance workloads involving reconciliation, point-in-time history, and auditability
- Strong knowledge of PHI, HIPAA, and controls relevant to revenue and CMS-submission data
- Familiarity with 834 and 837 transactions, ICD-10, and HCC assignment
- SAS experience is preferred, particularly with legacy actuarial extracts
- Direct experience with RA files including MMR, MOR, MAO-004, and EDS or encounter status
- Experience developing member-level RA engines, suspect or recapture warehouses, or revenue-forecast data products
- Bachelor’s degree in computer science, engineering, or a 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
- Additional resources supporting physical, emotional, and financial well-being
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