Medicare PDE & Claims Analytics Lead

CVS Health; Madison (WI); Sur place; USD 47 000 - 112 000; Plein temps

Avantages offerts par ce poste

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Résumé du poste

CVS Health in Madison, WI is seeking a full-time Claims Analyst to review PDE errors, analyze rejections and distribute reports to internal and external clients. The role serves as a liaison between the PDE Reporting Team and related entities to ensure timely resolution of issues and adherence to CMS deadlines.

The ideal candidate has 3+ years in government-regulated health programs, a Bachelor's degree (or equivalent), and proficiency with SQL, Python, Word and Excel.

Qualifications

• 3+ years of experience with government-regulated health programs.
• Bachelor's degree preferred or equivalent work experience.
• Experience with Medicaid/Medicare and/or Exchanges is a plus.

Responsabilités

• Review claims and PDE errors; analyze PDE rejections and distribute reports.
• Serve as liaison between PDE Reporting Team and other entities to ensure timely resolution.
• Coordinate research and respond to external clients per CMS deadlines.
• Assist with weekly PDE meetings and improve Medicare claims data through root-cause analysis.
• Apply CMS guidance and ensure CMS compliance.

Connaissances

SQL

Python

Formation

Bachelor's degree preferred or equivalent work experience

Outils

Microsoft Word

Microsoft Excel

Description du poste

CVS Health in Madison, WI is seeking a full-time Claims Analyst to review PDE errors, analyze rejections and distribute reports to internal and external clients. The role serves as a liaison between the PDE Reporting Team and related entities to ensure timely resolution of issues and adherence to CMS deadlines.

The ideal candidate has 3+ years in government-regulated health programs, a Bachelor's degree (or equivalent), and proficiency with SQL, Python, Word and Excel.