Medicare PDE & Claims Analytics Specialist

CVS Health; Rhode Island; Hybrid; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a PDE Claims Analyst to review claims and PDE errors, analyze PDE Rejections, and distribute reports to internal and external clients. You will coordinate with the PDE Reporting Team, PDE Eligibility/Reconciliation, and other departments to meet CMS deadlines.

Responsibilities include reviewing Acumen Outliers, researching issues, and presenting timely responses. This role requires knowledge of Part D plans, CMS guidance, and a commitment to accuracy, safety, and quality in

Qualifications

• 3+ years experience with government-regulated health programs in financial operations.
• Bachelor's degree or equivalent work experience preferred.
• Excellent written and verbal communication with clients and agencies.
• Proficiency in Microsoft Word and Excel; SQL and Python preferred.

Responsibilities

• Review claims and PDE errors; analyze PDE Rejections.
• Distribute PDE Rejections reports to internal and external clients.
• Coordinate research with departments and respond to CMS deadlines.
• Assist with weekly PDE meetings and maintain stakeholder communications.
• Perform root-cause and impact analysis to improve Medicare claims data.

Skills

Communication skills

Organizational skills

Time management

Attention to detail

Education

Bachelor's degree or equivalent work experience

Tools

SQL

Python

Microsoft Word

Microsoft Excel

Job description

CVS Health is seeking a PDE Claims Analyst to review claims and PDE errors, analyze PDE Rejections, and distribute reports to internal and external clients. You will coordinate with the PDE Reporting Team, PDE Eligibility/Reconciliation, and other departments to meet CMS deadlines.

Responsibilities include reviewing Acumen Outliers, researching issues, and presenting timely responses. This role requires knowledge of Part D plans, CMS guidance, and a commitment to accuracy, safety, and quality in