Medicare Claims & PDE Analytics Lead

CVS Health; Jackson (MS); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical/Dental/Vision

Paid time off

Retirement plan

Wellness programs

Job summary

CVS Health in the United States is seeking a Claims Reviewer to analyze Medicaid/Medicare PDE errors and coordinate responses to external clients. You will review PDE Rejections, distribute reports, and liaise between the PDE Reporting Team and other stakeholders to ensure timely resolution.

The role requires strong analytical skills, CMS guidance knowledge, and proficiency with Word, Excel, and SQL or Python.

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations and/or related experience.
• Bachelor’s degree preferred or equivalent work experience required.

Responsibilities

• Review claims and PDE errors and analyze PDE Rejections reports.
• Serve as liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation and other involved entities.
• Coordinate research with various departments and submit responses to external clients or Acumen according to CMS deadlines.
• Assist with the weekly PDE meetings and help drive continuous improvement of Medicare claims data.

Skills

Communication

Time management

Organization

Word/Excel

Education

Bachelor’s degree or equivalent

Tools

SQL

Python

Job description

CVS Health in the United States is seeking a Claims Reviewer to analyze Medicaid/Medicare PDE errors and coordinate responses to external clients. You will review PDE Rejections, distribute reports, and liaise between the PDE Reporting Team and other stakeholders to ensure timely resolution.

The role requires strong analytical skills, CMS guidance knowledge, and proficiency with Word, Excel, and SQL or Python.