Medicare Claims & PDE Analytics Specialist

CVS Health; United States; Remote; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in the United States is seeking a claims reviewer to analyze PDE errors and distribute PDE Rejections reports to internal teams and clients. You will coordinate with the PDE Reporting Team, PDE Eligibility/Reconciliation, and other stakeholders to ensure timely, accurate resolutions in line with CMS deadlines.

The role requires strong communication, organization, and time management skills, with working knowledge of Part D plans and the ability to interpret CMS guidance and ensure

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations and/or related experience (Medicaid, Medicare, and/or Exchanges).
• Bachelor's degree preferred or equivalent work experience required.

Responsibilities

• Review claims and PDE errors and analyze PDE Rejections reports.
• Distribute PDE Rejections analysis to internal and external clients.
• Serve as liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation and all related entities.
• Coordinate research with various departments and submit responses to CMS deadlines.
• Assist with weekly PDE meetings and drive continuous improvement of Medicare claims data through root cause analysis.
• Study and interpret CMS guidance to ensure compliance.

Skills

Excellent written communication

Verbal communication

Strong organizational skills

Time management

SQL

Python

Microsoft Word

Excel

CMS guidance interpretation

Education

Bachelor's degree or equivalent

Tools

SQL

Python

Microsoft Excel

Job description

CVS Health in the United States is seeking a claims reviewer to analyze PDE errors and distribute PDE Rejections reports to internal teams and clients. You will coordinate with the PDE Reporting Team, PDE Eligibility/Reconciliation, and other stakeholders to ensure timely, accurate resolutions in line with CMS deadlines.

The role requires strong communication, organization, and time management skills, with working knowledge of Part D plans and the ability to interpret CMS guidance and ensure