Medicare PDE & Claims Data Analyst

CVS Health; Lake Michigan Beach (MI); On-site; USD 47,000 - 112,000; Full time

Job summary

CVS Health is seeking a PDE Claims reviewer to analyze, research, and resolve PDE rejections. You will coordinate with the PDE Reporting Team and other departments to ensure timely responses to CMS deadlines and improve the accuracy of Medicare claims data.

This full-time role requires at least 3 years in government-regulated health programs, with strong SQL/Python skills and proficiency in MS Word and Excel. Bachelor's degree or equivalent experience is preferred.

Qualifications

• 3 years minimum experience with government-regulated health programs (Medicaid, Medicare, and/or Exchanges).
• Experience with financial operations in government programs is preferred.
• Bachelor's degree preferred or equivalent work experience.

Responsibilities

• Review PDE errors and distribute PDE Rejections reports to internal and external clients.
• Coordinate research with various departments and submit responses to CMS deadlines.
• Assist with the weekly PDE meetings and drive continuous improvement of Medicare claims data.

Skills

SQL

Python

Word

Excel

Education

Bachelor's degree

Tools

Acumen

Job description

CVS Health is seeking a PDE Claims reviewer to analyze, research, and resolve PDE rejections. You will coordinate with the PDE Reporting Team and other departments to ensure timely responses to CMS deadlines and improve the accuracy of Medicare claims data.

This full-time role requires at least 3 years in government-regulated health programs, with strong SQL/Python skills and proficiency in MS Word and Excel. Bachelor's degree or equivalent experience is preferred.