Medicare Claims & PDE Reconciliation Analyst

CVS Health; Massachusetts; Hybrid; USD 47,000 - 112,000; Full time

Job summary

CVS Health is seeking a Claims Analyst to review Medicare PDE errors and related reports, distributing findings to internal and external clients. You will serve as a liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation, and other entities to ensure timely, accurate resolution of rejections.

A Bachelor’s degree is preferred, with at least 3 years’ experience handling government-regulated health programs.

Qualifications

• 3+ years experience with government-regulated health programs in financial operations.
• Bachelor's degree preferred or equivalent work experience.
• Strong written and verbal communication skills; ability to interact with clients and agencies.
• Proficiency with Microsoft Word and Excel; SQL and/or Python experience.

Responsibilities

• Review claims and PDE errors and analyze PDE Rejections; distribute reports to internal and external clients.
• Coordinate research with various departments and submit responses to external clients or Acumen according to CMS deadlines.
• Assist with the weekly PDE meetings and ensure timely resolutions of issues.
• Improve Medicare claims data through root cause and impact analysis of errors and recommendations for systems and procedure enhancements.
• Rely on knowledge of Part D plans and CMS guidance to ensure compliance.

Skills

Excellent written and verbal沟通 skills

Education

Bachelor's degree preferred or equivalent work experience

Tools

Microsoft Word

Microsoft Excel

SQL

Python

Job description

CVS Health is seeking a Claims Analyst to review Medicare PDE errors and related reports, distributing findings to internal and external clients. You will serve as a liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation, and other entities to ensure timely, accurate resolution of rejections.

A Bachelor’s degree is preferred, with at least 3 years’ experience handling government-regulated health programs.