Medicare PDE Claims Analyst - Data & Compliance

CVS Health; Nebraska; Ibrido; USD 47.000 - 112.000; Tempo pieno

Vantaggi offerti da questo lavoro

Bonus eligibility

Commission or short-term incentive

Descrizione del lavoro

CVS Health is hiring for a full-time role focused on reviewing claims and PDE errors, coordinating cross‑department research, and ensuring CMS compliance. The position requires navigating Medicare data, reporting, and stakeholder communication to resolve PDE rejections efficiently.

The ideal candidate has 3+ years in government-regulated health programs, strong Excel/Word skills, and experience with SQL or Python.

Competenze

• 3 years minimum experience with government-regulated health programs within financial operations and/or related experience (Medicaid, Medicare, and/or Exchanges).
• Bachelor's degree preferred or equivalent work experience required.
• Excellent written and verbal communication skills for interaction with clients, internal partners, and government agencies.
• Strong organizational skills and ability to manage multiple projects simultaneously.
• Excellent time management skills as these requests are time sensitive.
• Proficiency with SQL and/or Python.
• Proficiency with Microsoft Word and Excel.

Mansioni

• 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 per CMS deadlines.
• Serve as liaison between PDE Reporting Team, PDE Eligibility/Reconciliation and related entities.
• Assist with weekly PDE meetings and support continuous improvement of Medicare claims data.
• Provide root cause analysis and recommendations for system and process enhancements.
• Ensure compliance with CMS guidance and regulatory requirements.

Conoscenze

Communication skills

Time management

Analytical thinking

SQL

Python

Formazione

Bachelor's degree or equivalent experience

Strumenti

Microsoft Excel

Microsoft Word

Descrizione del lavoro

CVS Health is hiring for a full-time role focused on reviewing claims and PDE errors, coordinating cross‑department research, and ensuring CMS compliance. The position requires navigating Medicare data, reporting, and stakeholder communication to resolve PDE rejections efficiently.

The ideal candidate has 3+ years in government-regulated health programs, strong Excel/Word skills, and experience with SQL or Python.