Medicare Claims & PDE Analyst

CVS Health; Phoenix (AZ); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Comprehensive benefits package

Job summary

CVS Health is seeking a detail-oriented professional to review Medicare PDE errors and analyze rejections. The role involves coordinating with the PDE Reporting Team and other departments to ensure timely, accurate resolutions in alignment with CMS deadlines.

Responsibilities include researching issues, assisting in weekly PDE meetings, and driving continuous improvement of Medicare claims data through root cause analysis and recommended system enhancements. Strong communication is essential.

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations and/or related experience (Medicaid, Medicare, and/or Exchanges).
• Excellent written and verbal communication skills for interaction with clients, internal partners, and government agencies.
• Strong organizational skills and ability to manage multiple projects simultaneously.
• Excellent time management skills as these requests are time sensitive.
• Proficiency with Microsoft Word and Excel.
• Proficiency with SQL and/or Python.

Responsibilities

• Review claims and PDE (Prescription Drug Event) errors and analyze PDE Rejections reports.
• Serve as liaison between PDE Reporting Team, PDE Eligibility/Reconciliation and all related entities.
• Coordinate research with various departments and submit responses to external clients or Acumen according to CMS deadlines.
• Assist with weekly PDE meetings and ensure accuracy and timeliness of responses.
• Identify root causes and recommend enhancements to Medicare claims data and systems.

Skills

Communication

Organizational skills

Time management

Education

Bachelor's degree preferred or equivalent work experience

Tools

Microsoft Word

Microsoft Excel

SQL

Python

Job description

CVS Health is seeking a detail-oriented professional to review Medicare PDE errors and analyze rejections. The role involves coordinating with the PDE Reporting Team and other departments to ensure timely, accurate resolutions in alignment with CMS deadlines.

Responsibilities include researching issues, assisting in weekly PDE meetings, and driving continuous improvement of Medicare claims data through root cause analysis and recommended system enhancements. Strong communication is essential.