Medicare PDE Claims Analyst

CVS Health; Atlanta (GA); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Bonus eligibility

Job summary

CVS Health is seeking a claims and PDE specialist to review and resolve Prescription Drug Event errors. You will analyze PDE Rejections, share insights with clients, and coordinate with the PDE Reporting Team and CMS deadlines to ensure accurate resolutions.

Ideal candidates have 3+ years in government-regulated health programs, strong communication skills, and proficiency in Excel and SQL/Python. This full-time role offers comprehensive benefits and a potential bonus option.

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations and/or related roles.
• Experience with Medicaid, Medicare, and/or Exchanges.
• Proficiency with Microsoft Word and Excel.
• Proficiency with SQL and/or Python is preferred or helpful.

Responsibilities

• Review claims and PDE (Prescription Drug Event) errors.
• Analyze and distribute PDE Rejections reports to internal and external clients.
• Act as liaison between PDE Reporting Team, PDE Eligibility/Reconciliation and related entities.
• Coordinate research with departments and respond to external clients per CMS deadlines.
• Assist with weekly PDE meetings and improve Medicare claims data quality.

Skills

Communication

Excel

SQL

Python

Time management

Education

Bachelor's degree or equivalent work experience

Tools

Microsoft Word

Job description

CVS Health is seeking a claims and PDE specialist to review and resolve Prescription Drug Event errors. You will analyze PDE Rejections, share insights with clients, and coordinate with the PDE Reporting Team and CMS deadlines to ensure accurate resolutions.

Ideal candidates have 3+ years in government-regulated health programs, strong communication skills, and proficiency in Excel and SQL/Python. This full-time role offers comprehensive benefits and a potential bonus option.