Medicare PDE Analytics Specialist

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a claims and PDE reviewer responsible for analyzing PDE errors, reviewing PDE Rejections reports, and coordinating responses to internal and external clients.

You will liaise with the PDE Reporting Team, PDE Eligibility/Reconciliation, and other departments to ensure timely, accurate resolution of PDE Rejections, review CMS guidance, and contribute to ongoing process improvements in Medicare claims data.

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations and/or related experience.

Responsibilities

• Review claims and PDE (Prescription Drug Event) errors and analyze PDE Rejections reports.
• Coordinate the research with various departments and submit responses to external clients or Acumen according to CMS deadlines.
• Assist with the weekly PDE meetings and ensure continuous improvement of Medicare claims data through root cause and impact analysis of errors.

Skills

SQL

Python

MS Word & Excel

Communication

Time management

Organizational skills

Education

Bachelor's degree or equivalent work experience

Tools

SQL

Python

Job description

CVS Health is seeking a claims and PDE reviewer responsible for analyzing PDE errors, reviewing PDE Rejections reports, and coordinating responses to internal and external clients.

You will liaise with the PDE Reporting Team, PDE Eligibility/Reconciliation, and other departments to ensure timely, accurate resolution of PDE Rejections, review CMS guidance, and contribute to ongoing process improvements in Medicare claims data.