Medicare Claims & PDE Analytics Specialist

CVS Health; Utah; Ibrido; USD 47.000 - 112.000; Tempo pieno

Vantaggi offerti da questo lavoro

Comprehensive benefits

Medical/Dental/Vision coverage

Retirement savings options

Wellness programs

Paid time off

Descrizione del lavoro

CVS Health is seeking a full-time Claims & PDE Reviewer to analyze PDE rejections, coordinate research, and ensure timely, accurate resolutions in line with CMS deadlines. You will liaise with the PDE Reporting Team and external clients to drive process improvements.

The role requires 3+ years in government-regulated health programs, strong communication, and proficiency with Word/Excel; SQL or Python is a plus. Competitive benefits and a comprehensive compensation package are offered.

Competenze

• 3 years minimum experience with government-regulated health programs within financial operations and/or related experience (Medicaid, Medicare, and/or Exchanges).
• Experience communicating with clients, internal partners, and government agencies is preferred.
• Excellent written and verbal communication skills are essential.
• Strong organizational and multi-project management abilities are expected.

Mansioni

• Review claims and PDE (Prescription Drug Event) errors and analyze PDE Rejections reports.
• Coordinate research with multiple departments and respond to external clients or Acumen according to CMS deadlines.
• Serve as liaison between PDE Reporting Team, PDE Eligibility/Reconciliation and involved entities.
• Assist with weekly PDE meetings and contribute to continuous improvement of Medicare claims data through root cause analysis.

Conoscenze

Communication skills

Organizational skills

Time management

Formazione

Bachelor's degree preferred or equivalent

Strumenti

Microsoft Word

Microsoft Excel

SQL

Python

Descrizione del lavoro

CVS Health is seeking a full-time Claims & PDE Reviewer to analyze PDE rejections, coordinate research, and ensure timely, accurate resolutions in line with CMS deadlines. You will liaise with the PDE Reporting Team and external clients to drive process improvements.

The role requires 3+ years in government-regulated health programs, strong communication, and proficiency with Word/Excel; SQL or Python is a plus. Competitive benefits and a comprehensive compensation package are offered.