Medicare Claims & PDE Rejections Analyst

CVS Health; Arkansas City (KS); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Comprehensive benefits

Job summary

CVS Health is seeking a detail-oriented analyst to review Medicare PDE claims and errors, coordinating across the PDE Reporting Team and CMS requirements. You will help resolve rejections, review outliers, and support weekly PDE meetings.

The role requires knowledge of Part D plans and CMS guidance, with 3 years of government-regulated health program experience. A bachelor’s degree is preferred and a comprehensive benefits package is included.

Qualifications

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

Responsibilities

• Review claims and PDE (Prescription Drug Event) errors and analyze PDE Rejections.
• Coordinate with PDE Reporting Team, PDE Eligibility/Reconciliation and other entities to ensure timely resolution of PDE Rejections.
• Review Acumen Outliers and coordinate research with various departments; respond to external clients per CMS deadlines.
• Assist weekly PDE meetings and contribute to continuous improvement of Medicare claims data via root-cause analysis and recommendations.

Skills

Communication skills

Time management

Organizational skills

Microsoft Word

Microsoft Excel

SQL

Python

Education

Bachelor's degree

Tools

SQL

Python

Job description

CVS Health is seeking a detail-oriented analyst to review Medicare PDE claims and errors, coordinating across the PDE Reporting Team and CMS requirements. You will help resolve rejections, review outliers, and support weekly PDE meetings.

The role requires knowledge of Part D plans and CMS guidance, with 3 years of government-regulated health program experience. A bachelor’s degree is preferred and a comprehensive benefits package is included.