Medicare Claims & PDE Analytics Lead

CVS Health; Helena (MT); Vor Ort; USD 47.000 - 112.000; Vollzeit

Benefits dieser Stelle

Medical, dental, and vision coverage

Retirement savings options

Paid time off

Zusammenfassung

CVS Health is seeking a claims reviewer to analyze PDE errors and oversee the PDE Rejections reports. You will liaison with the PDE Reporting Team, PDE Eligibility/Reconciliation, and external clients to ensure timely CMS-compliant resolutions.

You will coordinate research with multiple departments, review Acumen Outliers, and support weekly PDE meetings. A background in Part D and CMS guidance is essential, with strong data analysis and communication skills.

Qualifikationen

• 3 years minimum experience with government-regulated health programs within financial operations.
• Bachelor’s degree preferred or equivalent work experience.
• Experience with CMS guidance and Part D plans is a plus.
• Proficiency with Word, Excel; SQL and/or Python helpful.

Aufgaben

• Review claims and PDE errors and distribute PDE Rejections reports.
• Serve as liaison between PDE Reporting Team, PDE Eligibility/Reconciliation and related entities.
• Coordinate research with departments and respond to external clients per CMS deadlines.
• Assist with weekly PDE meetings and drive improvements to Medicare claims data through root cause analysis.

Kenntnisse

Excellent written and verbal communica

Strong organizational skills

Excellent time management

Ausbildung

Bachelor’s degree

Tools

Microsoft Word

Excel

SQL

Python

Jobbeschreibung

CVS Health is seeking a claims reviewer to analyze PDE errors and oversee the PDE Rejections reports. You will liaison with the PDE Reporting Team, PDE Eligibility/Reconciliation, and external clients to ensure timely CMS-compliant resolutions.

You will coordinate research with multiple departments, review Acumen Outliers, and support weekly PDE meetings. A background in Part D and CMS guidance is essential, with strong data analysis and communication skills.