CVS Health
CVS Health
CVS Health ir Amerikas Savienoto Valstu veselības aprūpes uzņēmums, kas darbojas veselības aprūpes pakalpojumu, veselības apdrošināšanas, aptieku pabalstu pārvaldības un mazumtirdzniecības aptieku jomā. Ar tādiem uzņēmumiem kā Aetna un CVS Caremark tas atbalsta veselības apdrošināšanas segumu, recepšu medikamentu pieejamību, veselības stāvokļa pārvaldību, specializētus medikamentus un medikamentu pasūtīšanu pa pastu. Uzņēmuma apkārtnes aptiekas un plašāki aprūpes pakalpojumi ir veidoti, lai cilvēki varētu ērtāk un izdevīgāk saņemt būtiski nepieciešamo veselības aprūpi. CVS Health apvieno apdrošināšanu, aptieku un veselības aprūpes pakalpojumus, lai atbalstītu cilvēkus un kopienas visā viņu aprūpes ceļā.

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.

Apraksts

  • 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

Prasības

  • 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

Priekšrocības

  • 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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