Medicare PDE & Claims Analyst

CVS Health; Colorado Springs (CO); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Retirement savings options

Job summary

CVS Health in Colorado Springs, CO is seeking a Claims & PDE Analyst to review PDE errors and coordinate responses to CMS deadlines. You’ll liaise with the PDE Reporting Team and other departments to ensure timely, accurate resolutions and continuous improvement in Medicare claims data.

The role requires 3+ years in government-regulated health programs, a Bachelor's degree (or equivalent), and strong SQL/Python, Excel, and Word skills.

Qualifications

• 3+ years in government-regulated health programs in financial operations.
• Excellent written and verbal communication with clients and agencies.
• Strong organizational skills; able to manage multiple projects.
• Excellent time management for time-sensitive requests.
• Proficiency with Word and Excel.
• Proficiency with SQL and/or Python.
• Bachelor's degree or equivalent work experience preferred

Responsibilities

• Review claims and PDE errors and distribute PDE Rejections reports to internal/external clients.
• Serve as liaison between PDE Reporting Team, PDE Eligibility/Reconciliation and related entities to ensure timely resolution.
• Coordinate research with departments and submit responses to external clients per CMS deadlines.
• Assist with weekly PDE meetings and drive continuous improvement of Medicare claims data through root cause analysis.
• Interpret CMS guidance and ensure compliance with CMS requirements.

Skills

SQL

Python

Excel

Word

Communication

Time management

Organizational skills

Education

Bachelor's degree

Job description

CVS Health in Colorado Springs, CO is seeking a Claims & PDE Analyst to review PDE errors and coordinate responses to CMS deadlines. You’ll liaise with the PDE Reporting Team and other departments to ensure timely, accurate resolutions and continuous improvement in Medicare claims data.

The role requires 3+ years in government-regulated health programs, a Bachelor's degree (or equivalent), and strong SQL/Python, Excel, and Word skills.