Senior Manager, Data Engineering – Medicare Revenue

This is a fully remote position, open to applicants in Alabama, +41 more states.

📋 Description

• Take charge of the data infrastructure that underpins the Medicare revenue operations.

• Design, construct, and manage data pipelines and analytical tables for Medicare revenue forecasting models.

• Ingest, standardize, and reconcile claims, encounters, eligibility/enrollment data, EMR/chart extracts, vendor/program files, and CMS artifacts.

• Implement HCC / ICD-10 mapping, manage model-year versioning, and differentiate between diagnosis-year and payment-year constructs.

• Oversee data quality, reconciliation, lineage, and processes for snapshot/freeze related to accruals, AtoE, and audit compliance.

• Collaborate with enterprise data/IT on standards for Databricks or similar lakehouse solutions, as well as Spark/PySpark, orchestration, CI/CD, access control, and cost/performance optimization.

• Provide well-documented datasets to Modeling, Finance, Actuarial, and Revenue Integrity teams.

• Establish and monitor freshness and completeness SLAs while tracking data drift and changes in source systems.

• Lead and mentor data engineers, promoting best engineering practices in a regulated, financially sensitive environment.

• Assist with modular revenue, membership/mix analysis, and related outputs.

⛳️ Requirements

• A minimum of 8 years in data engineering.

• At least 4 years of advanced experience in healthcare data management, including claims, encounters, eligibility, provider, and clinical/chart sources.

• Over 4 years of practical experience with Databricks / Spark (PySpark), Python, SQL, lakehouse / ELT patterns, orchestration tools like Airflow or equivalent, and data quality frameworks.

• More than 4 years of experience in supporting risk-adjustment, actuarial, or finance workloads, focusing on reconciliation, point-in-time history, and auditability.

• Strong knowledge of PHI, HIPAA regulations, and controls relevant to revenue and CMS-submission data.

• Familiarity with 834/837 transaction sets, ICD-10 coding, and HCC assignment.

• SAS experience is a plus, particularly for legacy actuarial extracts.

• Direct experience with RA files including MMR, MOR, MAO-004, and EDS/encounter status.

• Previous involvement with member-level RA engines, suspect/recapture warehouses, or revenue-forecast data products.

• Bachelor’s degree in Computer Science, engineering, or a related field, or equivalent professional experience.

🏝️ Benefits

• 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 that support physical, emotional, and financial well-being.