Medicare Claims Analyst - PDE & Reconciliation Specialist

CVS Health; Lansing (MI); Sur place; USD 47 000 - 112 000; Plein temps

Avantages offerts par ce poste

Medical coverage

Dental coverage

Vision coverage

Paid time off

Résumé du poste

CVS Health in Lansing is seeking a Claims Review Specialist to review government claims and PDE errors, coordinating with the PDE Reporting Team and internal partners to ensure accurate, timely resolutions.

You will analyze Acumen Outliers, coordinate research with multiple departments, and submit CMS-compliant responses to external clients, while supporting weekly PDE meetings and process improvements.

Qualifications

• 3 years minimum experience with government-regulated health programs in financial operations.
• Experience with Medicaid, Medicare, or Exchanges preferred.
• Bachelor's degree or equivalent work experience preferred.

Responsabilités

• Review claims and PDE (Prescription Drug Event) errors.
• Analyze and distribute PDE Rejections reports to internal and external clients.
• Coordinate research with various departments and submit responses to external clients per CMS deadlines.
• Assist with weekly PDE meetings and drive continuous improvement of Medicare claims data.

Connaissances

Communication skills

Organizational skills

Time management

Formation

Bachelor's degree

Outils

Microsoft Word

Excel

SQL

Python

Description du poste

CVS Health in Lansing is seeking a Claims Review Specialist to review government claims and PDE errors, coordinating with the PDE Reporting Team and internal partners to ensure accurate, timely resolutions.

You will analyze Acumen Outliers, coordinate research with multiple departments, and submit CMS-compliant responses to external clients, while supporting weekly PDE meetings and process improvements.