Medicare PDE Claims Analyst – Data & Compliance

CVS Health; Arkansas; Hybride; USD 47 000 - 112 000; Plein temps

Avantages offerts par ce poste

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings plan

Wellness programs

Résumé du poste

CVS Health is seeking a Claims and PDE Reviewer to analyze PDE errors, review Rejections, and distribute reports to internal and external clients. This role serves as a liaison between PDE Reporting, Eligibility/Reconciliation, and other stakeholders to ensure timely resolution of PDE rejections.

Responsibilities include reviewing Acumen Outliers, coordinating with CMS deadlines, and assisting with weekly PDE meetings.

Qualifications

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

Responsabilités

• Review claims and PDE errors and analyze PDE Rejections.
• Distribute PDE Rejections reports to internal and external clients and act as liaison across PDE teams.
• Coordinate research with various departments and respond to external clients or Acumen per CMS deadlines.
• Assist with weekly PDE meetings and drive continuous improvement of Medicare claims data through root cause analysis.

Connaissances

SQL

Python

Excel

Communication

Formation

Bachelor's degree

Outils

Microsoft Word

Microsoft Excel

Description du poste

CVS Health is seeking a Claims and PDE Reviewer to analyze PDE errors, review Rejections, and distribute reports to internal and external clients. This role serves as a liaison between PDE Reporting, Eligibility/Reconciliation, and other stakeholders to ensure timely resolution of PDE rejections.

Responsibilities include reviewing Acumen Outliers, coordinating with CMS deadlines, and assisting with weekly PDE meetings.