Senior Manager, Data Engineering — Medicare Revenue

CVS Health Corporation; United States; Remote; USD 83,000 - 183,000; Full time

Benefits offered by this job

Medical insurance

Dental coverage

Vision coverage

Paid time off

Job summary

CVS Health Corporation is seeking a senior data engineering leader to design, build, and operate data pipelines feeding Medicare revenue projections. You will ingest and reconcile claims, eligibility data, and CMS artifacts while implementing HCC/ICD-10 mappings and model-year versioning.

You will own data quality, lineage, and snapshot processes, partner with enterprise data/IT on lakehouse standards, and mentor engineers in a regulated health data environment.

Qualifications

• 8+ years in data engineering.
• 4+ years of healthcare data experience: claims, encounters, eligibility, provider, and chart sources.
• 4+ years of production experience with Databricks / Spark (PySpark), Python, SQL, Lakehouse / ELT patterns, orchestration (Airflow or equivalent), and data-quality frameworks.
• 4+ years supporting risk-adjustment, actuarial, or finance workloads (reconciliation, history, auditability).
• Strong understanding of PHI, HIPAA, and controls for revenue and CMS data.

Responsibilities

• Design, build, and operate data pipelines and analytic tables feeding Medicare revenue projections.
• Ingest, normalize, and reconcile claims/encounters, eligibility/enrollment, EMR/chart extracts, vendor files, and CMS artifacts.
• Implement HCC/ICD-10 mapping and versioning for model year constructs.
• Own data quality, reconciliation, lineage, and snapshot/freeze processes for accruals and audits.
• Partner with enterprise data/IT on Databricks lakehouse standards: Spark/PySpark, orchestration, CI/CD, access control, cost/performance.
• Provide trusted datasets to Modeling, Finance, Actuarial, and Revenue Integrity.

Skills

Data engineering

Healthcare data

Databricks / Spark (PySpark)

Python

SQL / Lakehouse / ELT

Airflow or equivalent

Data quality & reconciliation

Education

Bachelor’s degree in CS/engineering or related field

Tools

Databricks

Spark (PySpark)

Python

SQL

Airflow

Job description

Role summary

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

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.

Required Qualifications

• 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.

Preferred Qualifications

• 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.

Education

Bachelor’s in CS, engineering, or related field (or equivalent experience)

Pay Range

The typical pay range for this role is: $82,940.00 - $182,549.00 This pay range represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Benefits

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 10/30/2026

Application Notes

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Company Culture

Our Work Experience is the combination of everything that’s unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it’s our people. Our employees are self‑disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.