Medicare PDE Claims Analyst

CVS Health; Idaho Falls (ID); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Paid time off

Job summary

CVS Health is seeking a detail-oriented claims reviewer to support PDE error analysis and resolutions. You will analyze PDE rejections, coordinate with the PDE Reporting Team and CMS deadlines, and prepare responses for internal and external clients to improve Medicare claims data.

The role requires at least 3 years of government-regulated health programs experience, strong communication, and proficiency with Word, Excel, SQL or Python. Bachelor's degree preferred or equivalent work experience.

Qualifications

• 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 research with various departments and submit responses to external clients or Acumen according to CMS deadlines.
• Assist with weekly PDE meetings and ensure continuous improvement of Medicare claims data through root cause analysis of errors and recommendations for system and procedure enhancements.

Skills

SQL

Python

MS Word

MS Excel

Communication

Time management

Organization

Education

Bachelor's degree or equivalent work experience

Tools

Microsoft Word

Microsoft Excel

Job description

CVS Health is seeking a detail-oriented claims reviewer to support PDE error analysis and resolutions. You will analyze PDE rejections, coordinate with the PDE Reporting Team and CMS deadlines, and prepare responses for internal and external clients to improve Medicare claims data.

The role requires at least 3 years of government-regulated health programs experience, strong communication, and proficiency with Word, Excel, SQL or Python. Bachelor's degree preferred or equivalent work experience.