Medicare Claims & PDE Analysis Specialist

CVS Health; Maryland; Ibrido; USD 47.000 - 112.000; Tempo pieno

Descrizione del lavoro

CVS Health is seeking a full-time professional to review PDE claims and errors, analyze rejections, and communicate findings to internal and external clients. You will liaise with the PDE Reporting Team and other departments to resolve CMS deadlines efficiently.

The role requires 3+ years in government-regulated health programs, strong communication, and proficiency with Word/Excel and basic SQL/Python. A CMS-compliant mindset and attention to detail are essential for ongoing process

Competenze

• Minimum 3 years of experience with government-regulated health programs in financial operations.
• Strong written and verbal communication skills.
• Ability to manage multiple projects with time sensitivity.
• Familiarity with CMS guidelines and Part D plans.

Mansioni

• Review claims and PDE (Prescription Drug Event) errors.
• Analyze and distribute PDE Rejections reports and analysis to clients.
• Serve as liaison between PDE Reporting Team and other departments.
• Coordinate research with various departments and respond to external clients per CMS deadlines.
• Assist with weekly PDE meetings and ensure timely resolutions.
• Improve Medicare claims data through root cause and impact analysis of errors.

Conoscenze

Govt health programs knowledge

Communication

Organization

Time management

CMS guidance interpretation

Formazione

Bachelor's degree or equivalent work experience

Strumenti

Microsoft Word

Microsoft Excel

SQL

Python

Descrizione del lavoro

CVS Health is seeking a full-time professional to review PDE claims and errors, analyze rejections, and communicate findings to internal and external clients. You will liaise with the PDE Reporting Team and other departments to resolve CMS deadlines efficiently.

The role requires 3+ years in government-regulated health programs, strong communication, and proficiency with Word/Excel and basic SQL/Python. A CMS-compliant mindset and attention to detail are essential for ongoing process