Medicare Claims & PDE Insight Lead

Colorado Psychiatric; Colorado; Sur place; USD 47 000 - 112 000; Plein temps

Avantages offerts par ce poste

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Résumé du poste

CVS Health is hiring for a role that reviews claims and PDE (Prescription Drug Event) errors, coordinating analysis and responses for internal teams and external clients. The position supports the PDE Reporting Team and CMS deadlines, ensuring accurate resolution of PDE rejections and continuous improvement of Medicare data.

The candidate should have at least 3 years of experience with government-regulated health programs, and a Bachelor's degree or equivalent experience is preferred.

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

Responsabilités

• Review claims and PDE (Prescription Drug Event) errors and analyze PDE Rejections.
• Distribute PDE Rejections reports to internal and external clients and coordinate responses.
• Serve as liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation and all related entities.
• Coordinate review with Acumen Outliers and CMS deadlines; ensure timely resolution of PDE Rejections.
• Assist with weekly PDE meetings and drive continuous improvement of Medicare claims data through root-cause analysis and suggested system/procedure enhancements.

Connaissances

SQL

Python

Microsoft Word

Excel

Formation

Bachelor's degree or equivalent work experience

Description du poste

CVS Health is hiring for a role that reviews claims and PDE (Prescription Drug Event) errors, coordinating analysis and responses for internal teams and external clients. The position supports the PDE Reporting Team and CMS deadlines, ensuring accurate resolution of PDE rejections and continuous improvement of Medicare data.

The candidate should have at least 3 years of experience with government-regulated health programs, and a Bachelor's degree or equivalent experience is preferred.