Medicare PDE & Claims Analytics Specialist

CVS Health; Manchester (NH); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Comprehensive benefits

Job summary

CVS Health is seeking a Claims and PDE Analyst to review claims and PDE errors, analyze PDE Rejections, and distribute reports to internal and external clients while ensuring timely resolution.

The role acts as a liaison among the PDE Reporting Team, Eligibility/Reconciliation, and other parties, coordinating CMS deadlines, researching with several departments, and contributing to continuous improvement of Medicare claims data through root cause analysis and system enhancements.

Qualifications

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

Responsibilities

• Review claims and PDE errors.
• Analyze and distribute PDE Rejections reports to internal and external clients.
• Serve as liaison between PDE Reporting Team, PDE Eligibility/Reconciliation and all PDE-related entities.
• Download and review Acumen Outliers.
• Coordinate research with various departments and submit responses to external clients or Acumen per CMS deadlines.
• Assist with weekly PDE meetings.
• Improve Medicare claims data through root-cause and impact analysis of errors; suggest system/process enhancements.

Skills

Communication

Time management

Organizational skills

Education

Bachelor's degree

Tools

SQL

Python

Excel

Job description

CVS Health is seeking a Claims and PDE Analyst to review claims and PDE errors, analyze PDE Rejections, and distribute reports to internal and external clients while ensuring timely resolution.

The role acts as a liaison among the PDE Reporting Team, Eligibility/Reconciliation, and other parties, coordinating CMS deadlines, researching with several departments, and contributing to continuous improvement of Medicare claims data through root cause analysis and system enhancements.