Medicare PDE Claims Analyst | Data & Process Improvement

CVS Health; Columbus (OH); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Health insurance

Dental and vision coverage

Paid time off

Job summary

CVS Health is seeking a detail-oriented professional to review claims and PDE errors, coordinating with multiple departments to resolve CMS-relevant issues. The role requires understanding Part D plans and CMS guidance, with daily tasks that include data analysis and external client communication.

The position emphasizes timely resolution, rigorous documentation, and adherence to regulatory timelines, offering a full-time schedule with comprehensive benefits. 40 hours per week.

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations and/or related experience (Medicaid, Medicare, and/or Exchanges).
• Experience with Medicaid, Medicare, and/or Exchanges and strong communication with clients and partners.

Responsibilities

• Review claims and PDE (Prescription Drug Event) errors.
• Analyze and distribute PDE Rejections reports to internal and external clients.
• Serve as liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation and related entities.
• Coordinate research with various 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.

Skills

Communication

Organizational skills

Time management

Education

Bachelor's degree preferred or equivalent

Tools

Microsoft Word

Excel

SQL

Python

Job description

CVS Health is seeking a detail-oriented professional to review claims and PDE errors, coordinating with multiple departments to resolve CMS-relevant issues. The role requires understanding Part D plans and CMS guidance, with daily tasks that include data analysis and external client communication.

The position emphasizes timely resolution, rigorous documentation, and adherence to regulatory timelines, offering a full-time schedule with comprehensive benefits. 40 hours per week.