Role summaryThis 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 RangeThe 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.
Great benefits for great peopleWe 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
