Senior Manager, Data Engineering — Medicare Revenue

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. Role summary This role owns the data foundation that the Medicare revenue engine runs on. It requires an expert in healthcare and risk-adjustment data, including claims, encounters, eligibility, clinical/chart sources, and CMS payment and diagnosis files. Expertisein production-grade platforms (Databricks / Spark lakehouse, Python, SQL) is also required. The job is to make member-month, diagnosis, and payment data timely, complete, lineage-traced, and auditable so Finance can forecast and book revenue with confidence.   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