Medicare PDE & Claims Analytics Lead

CVS Health; Salem (NH); Sur place; USD 47 000 - 112 000; Plein temps

Avantages offerts par ce poste

Comprehensive benefits package

Bonus eligibility

Résumé du poste

CVS Health is seeking a detail-oriented reviewer to oversee PDE errors and rejection analyses. You will coordinate between the PDE Reporting Team and other stakeholders to ensure timely resolutions in line with CMS deadlines.

The role requires experience with government-regulated health programs and a Bachelor's degree or equivalent, with a focus on accuracy and regulatory compliance. This is a full-time, on-site position with comprehensive benefits.

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/Exchanges is preferred.
• Bachelor's degree or equivalent work experience is preferred.

Responsabilités

• Review claims and PDE (Prescription Drug Event) errors and analyze PDE Rejections.
• Distribute PDE Rejections reports and coordinate with internal and external clients.
• Act as liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation, and related entities to ensure timely resolution.
• Coordinate research with various departments and submit responses to external clients per CMS deadlines.
• Assist with weekly PDE meetings and perform root cause and impact analysis of errors to improve Medicare claims data.
• Study CMS guidance and ensure compliance with CMS requirements.

Connaissances

SQL

Python

Excel

Microsoft Word

Formation

Bachelor's degree or equivalent work experience

Outils

Microsoft Word

Microsoft Excel

Description du poste

CVS Health is seeking a detail-oriented reviewer to oversee PDE errors and rejection analyses. You will coordinate between the PDE Reporting Team and other stakeholders to ensure timely resolutions in line with CMS deadlines.

The role requires experience with government-regulated health programs and a Bachelor's degree or equivalent, with a focus on accuracy and regulatory compliance. This is a full-time, on-site position with comprehensive benefits.