Senior Manager, Data Engineering — Medicare Revenue

CVS Health is building a more connected, convenient, and compassionate health experience around every individual. The Senior Manager, Data Engineering — Medicare Revenue owns the data foundation supporting Medicare revenue projections, including healthcare and risk-adjustment data pipelines, analytic tables, data quality, lineage, and auditability. The role also partners with enterprise data and IT teams and leads data engineers in a regulated, financially sensitive environment.

Responsibilities:

• Design, build, and operate the data pipelines and analytic tables that feed the Medicare revenue projection model (member-month grain, HCC/diagnosis history, engagement/visit flags, CMS files, program attributes)
• Ingest, normalize, and reconcile: claims/encounters (837 and internal), eligibility/enrollment, EMR/chart extracts, vendor/program files, and CMS artifacts (MMR, MOR, MAO-004, and related)
• Implement HCC / ICD-10 mapping, model-year (e.g., V24/V28) versioning, and diagnosis-year vs. payment-year constructs so modelers do not have to reverse-engineer source systems
• Own data quality, reconciliation, lineage, and snapshot/freeze processes required 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 trusted, documented datasets to Modeling, Finance, Actuarial, and (as needed) Revenue Integrity
• Define SLAs for freshness and completeness; monitor drift and source-system changes that would invalidate forecasts
• Lead and mentor data engineers; set engineering practices for a regulated, financially sensitive environment
• Support modular outputs (revenue, membership/mix, other items) so the engine can evolve without rewriting the warehouse

Requirements:

• 8+ years in data engineering
• 4+ years of expert level experience in healthcare data: claims, encounters, eligibility, provider, and clinical/chart sources
• 4+ years of hands-on production experience with Databricks / Spark (PySpark), Python, and SQL/ Lakehouse / ELT patterns, orchestration (e.g., Airflow or equivalent), and data-quality frameworks
• 4+ years of experience supporting risk-adjustment, actuarial, or finance workloads (reconciliation, point-in-time history, auditability)
• Strong understanding of PHI, HIPAA, and controls appropriate to revenue and CMS-submission data
• Bachelor's in CS, engineering, or related field (or equivalent experience)
• Familiarity with 834/837, ICD-10, and HCC assignment
• SAS (nice to have, especially for legacy actuarial extracts)
• Direct RA file experience (MMR, MOR, MAO-004, EDS/encounter status)
• Prior work on member-level RA engines, suspect/recapture warehouses, or revenue-forecast data products