Medicare Claims & PDE Rejections Analyst

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

Benefits offered by this job

Medical coverage

Dental and vision

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a PDE Reviewer to analyze and resolve Prescription Drug Event (PDE) errors and rejections. You will coordinate with the PDE Reporting Team, Eligibility/Reconciliation, and other entities to ensure timely resolutions aligned with CMS deadlines.

The role requires 3+ years in government-regulated health programs, strong analytical and communication skills, and proficiency with SQL/Python and Excel. This is a full-time position based in Michigan with comprehensive benefits.

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations and/or related experience (Medicaid, Medicare, and/or Exchanges).
• Preferred: Excellent written and verbal communication with clients and internal partners.
• Bachelor's degree preferred or equivalent work experience

Responsibilities

• Review claims and PDE errors and analyze PDE rejections.
• Coordinate research with departments and submit responses to external clients or Acumen according to CMS deadlines.
• Assist with weekly PDE meetings and drive continuous improvement of Medicare claims data

Skills

Communication skills

Organizational skills

Time management

Education

Bachelor's degree or equivalent

Tools

SQL

Python

Excel

Microsoft Word

Job description

CVS Health is seeking a PDE Reviewer to analyze and resolve Prescription Drug Event (PDE) errors and rejections. You will coordinate with the PDE Reporting Team, Eligibility/Reconciliation, and other entities to ensure timely resolutions aligned with CMS deadlines.

The role requires 3+ years in government-regulated health programs, strong analytical and communication skills, and proficiency with SQL/Python and Excel. This is a full-time position based in Michigan with comprehensive benefits.