Medicare Claims & PDE Analyst

CVS Health; Wyoming (MI); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Bonus program

Comprehensive benefits package

Job summary

CVS Health is seeking a full-time professional to review claims and PDE errors, coordinating responses to internal and external clients while ensuring timely resolution according to CMS deadlines. The role requires strong analytical and communication skills to liaise across teams including PDE Reporting and Eligibility/Reconciliation.

Ideal candidates will have experience with government-regulated health programs, proficiency in SQL/Python, and a Bachelor’s degree or equivalent experience.

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.

Responsibilities

• Review claims and PDE errors and analyze PDE Rejections.
• Coordinate research and respond to external clients or Acumen according to CMS deadlines.
• Serve as liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation and related entities.
• Assist with the weekly PDE meetings and drive continuous improvement of Medicare claims data through root cause analysis.
• Ensure compliance with CMS guidance and accurate interpretation of data.

Skills

Communication

Organizational skills

Time management

Microsoft Word

Excel

SQL

Python

Education

Bachelor's degree preferred or equivalent work experience

Tools

SQL

Python

Microsoft Word

Excel

Job description

CVS Health is seeking a full-time professional to review claims and PDE errors, coordinating responses to internal and external clients while ensuring timely resolution according to CMS deadlines. The role requires strong analytical and communication skills to liaise across teams including PDE Reporting and Eligibility/Reconciliation.

Ideal candidates will have experience with government-regulated health programs, proficiency in SQL/Python, and a Bachelor’s degree or equivalent experience.