CVS Health
CVS Health
CVS Health este o companie americană din domeniul sănătății, care activează în servicii medicale, asigurări de sănătate, gestionarea beneficiilor farmaceutice și farmacii cu vânzare cu amănuntul. Prin companii precum Aetna și CVS Caremark, aceasta sprijină acoperirea medicală, accesul la medicamente eliberate pe bază de rețetă, gestionarea afecțiunilor, medicamentele specializate și serviciile de farmacie prin comenzi prin poștă. Farmaciile sale de proximitate și serviciile extinse de îngrijire sunt concepute pentru a-i ajuta pe oameni să acceseze mai ușor și mai accesibil servicii medicale esențiale. CVS Health reunește asigurările, farmacia și serviciile de sănătate pentru a sprijini persoanele și comunitățile pe tot parcursul experienței lor de îngrijire.

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.

Descriere

  • 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

Cerințe

  • 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

Beneficii

  • 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

Locuri de muncă similare

RecruitGo

Remote Executive Assistant, Outreach and Marketing — Philippines

RecruitGo

Handle administrative support, CRM, outreach, and marketing for RecruitGo, an Employer of Record serving global clients with talent from emerging markets. Support two UK-facing clients with day-to-day administration and creative campaigns.

Deschide