Medicare Claims Data Analyst - PDE Rejections & Insights

CVS Health; Vermont; Hybrid; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a detail-oriented claims reviewer to analyze PDE errors and coordinate responses for internal teams and external clients. The role requires evaluating PDE rejections, liaising with multiple departments, and ensuring CMS deadlines are met.

A solid background in government-regulated health programs is essential. The successful candidate will participate in weekly PDE meetings and contribute to improvements in Medicare claims data, with emphasis on accuracy, timeliness, and

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations and/or related experience (Medicaid, Medicare, and/or Exchanges).

Responsibilities

• Review claims and PDE errors and analyze PDE Rejections reports for internal and external clients.
• Serve as liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation and other entities involved with PDE to ensure timely resolutions.
• Coordinate research and submit responses to external clients or Acumen according to CMS deadlines.
• Assist with the weekly PDE meetings and contribute to continuous improvement of Medicare claims data through root cause analysis.
• Study CMS guidance and ensure compliance with CMS requirements.

Skills

Communication skills

Organizational skills

Time management

Microsoft Word

Excel

SQL

Python

Education

Bachelor's degree or equivalent work experience

Tools

Microsoft Word

Excel

SQL

Python

Job description

CVS Health is seeking a detail-oriented claims reviewer to analyze PDE errors and coordinate responses for internal teams and external clients. The role requires evaluating PDE rejections, liaising with multiple departments, and ensuring CMS deadlines are met.

A solid background in government-regulated health programs is essential. The successful candidate will participate in weekly PDE meetings and contribute to improvements in Medicare claims data, with emphasis on accuracy, timeliness, and