CVS Health
CVS Health
CVS Health yra Jungtinių Amerikos Valstijų sveikatos priežiūros įmonė, veikianti sveikatos priežiūros paslaugų, sveikatos draudimo, vaistų išmokų administravimo ir mažmeninės prekybos vaistais srityse. Per tokias veiklas kaip „Aetna“ ir „CVS Caremark“ įmonė padeda užtikrinti sveikatos draudimo apsaugą, receptinių vaistų prieinamumą, ligų valdymą, specializuotus vaistus ir vaistų užsakymo paštu paslaugas. Jos vietinės vaistinės ir platesnės priežiūros paslaugos skirtos tam, kad žmonės galėtų patogiau ir prieinamiau gauti būtiną sveikatos priežiūrą. CVS Health sujungia draudimo, vaistinių ir sveikatos priežiūros paslaugas, kad padėtų žmonėms ir bendruomenėms viso jų priežiūros kelio metu.

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.

Aprašymas

  • 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

Reikalavimai

  • 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

Privalumai

  • 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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