Medicare Revenue Data Engineering Lead

9025 CVS Shared Services Resources LLC; Connecticut; Hybrid; USD 83,000 - 183,000; Full time

Job summary

CVS Health is building the data foundations for the Medicare revenue engine. This Senior Data Engineer role owns data pipelines, MRR, PHI controls, and lakehouse standards, collaborating with Modeling, Finance, and Actuarial teams to deliver timely, auditable data for forecasts.

You will lead Databricks/Spark-based work, implement HCC/ICD-10 mapping, ensure data quality and lineage, and mentor engineers in a regulated, healthcare-focused environment while driving CI/CD and cost/performance

Qualifications

• 8+ years in data engineering.
• 4+ years expert level experience in healthcare data: claims, encounters, eligibility, provider, and clinical/chart sources; 4+ years 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.

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 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 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.

Skills

Data engineering

Healthcare data

Python

SQL

PHI/HIPAA controls

Data governance

CI/CD

Leadership

Education

Bachelor's degree in CS, Engineering, or related field

Tools

Databricks / Spark

PySpark

Airflow

Job description

CVS Health is building the data foundations for the Medicare revenue engine. This Senior Data Engineer role owns data pipelines, MRR, PHI controls, and lakehouse standards, collaborating with Modeling, Finance, and Actuarial teams to deliver timely, auditable data for forecasts.

You will lead Databricks/Spark-based work, implement HCC/ICD-10 mapping, ensure data quality and lineage, and mentor engineers in a regulated, healthcare-focused environment while driving CI/CD and cost/performance