Medicare PDE & Claims Analytics Lead

CVS Health; Guin (AL); In loco; USD 47.000 - 112.000; Tempo pieno

Descrizione del lavoro

CVS Health is seeking a Claims Reviewer to analyze and resolve PDE errors for government-regulated health programs. The role reviews PDE rejections, coordinates with the PDE Reporting Team and CMS guidance, and supports deadlines.

Requires at least 3 years of experience with Medicaid/Medicare, strong communication, and proficiency in Word/Excel, SQL or Python. Bachelor's degree preferred or equivalent experience. Full-time in the United States.

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; ability to interact with clients and government agencies.
• Strong organizational skills and ability to manage multiple projects.
• Proficiency with Microsoft Word and Excel; proficiency with SQL and Python.

Mansioni

• Review claims and PDE errors, analyze PDE Rejections, and distribute reports to clients.
• Serve as liaison between PDE Reporting Team and other parties to ensure timely resolution.
• Coordinate research with departments and submit responses according to CMS deadlines.
• Assist with weekly PDE meetings and contribute to continuous improvement of Medicare claims data.
• Ensure compliance with CMS guidance and related regulations.

Conoscenze

Experience with government health

SQL

Python

Excellent communication

Formazione

Bachelor's degree preferred

Strumenti

Microsoft Word

Microsoft Excel

Descrizione del lavoro

CVS Health is seeking a Claims Reviewer to analyze and resolve PDE errors for government-regulated health programs. The role reviews PDE rejections, coordinates with the PDE Reporting Team and CMS guidance, and supports deadlines.

Requires at least 3 years of experience with Medicaid/Medicare, strong communication, and proficiency in Word/Excel, SQL or Python. Bachelor's degree preferred or equivalent experience. Full-time in the United States.