Medicare PDE & Claims Analytics Specialist

CVS Health; Philadelphia (Philadelphia County); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness program

Job summary

CVS Health is seeking a Claims Reviewer to join our PDE team in Philadelphia. You will review claims and PDE errors, analyze rejection data, and serve as a liaison between the PDE Reporting Team and related departments to ensure timely, accurate resolutions in compliance with CMS deadlines.

Ideal candidates have 3+ years of experience with government-regulated health programs, a Bachelor's degree or equivalent, and strong Excel/SQL skills.

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations and/or related experience.
• Bachelor's degree preferred or equivalent work experience.
• Experience with CMS guidance and regulatory requirements is helpful.
• Proficiency in documenting and communicating findings clearly.

Responsibilities

• Review claims and PDE errors.
• Analyze and distribute PDE Rejections reports to clients.
• Coordinate research with departments and submit responses to external clients per CMS deadlines.
• Assist with weekly PDE meetings.
• Identify root causes and recommend system and procedural improvements.

Skills

Excellent written and verbal comms

Organizational skills

Time management

Microsoft Word

Excel

SQL

Python

Education

Bachelor's degree or equivalent work experience

Tools

Microsoft Word

Excel

SQL

Python

Job description

CVS Health is seeking a Claims Reviewer to join our PDE team in Philadelphia. You will review claims and PDE errors, analyze rejection data, and serve as a liaison between the PDE Reporting Team and related departments to ensure timely, accurate resolutions in compliance with CMS deadlines.

Ideal candidates have 3+ years of experience with government-regulated health programs, a Bachelor's degree or equivalent, and strong Excel/SQL skills.