Medicare PDE & Claims Insight Analyst

CVS Health; Kansas; Ibrido; USD 47.000 - 112.000; Tempo pieno

Vantaggi offerti da questo lavoro

Comprehensive benefits

Paid time off

Retirement savings options

Descrizione del lavoro

CVS Health in the United States seeks a full-time Claims Reviewer to analyze PDE errors and manage PDE Rejections for CMS compliance. The role includes distributing reports to clients, coordinating with the PDE Reporting Team, and ensuring timely resolutions.

Qualifications include 3+ years in government-regulated health programs within financial operations, strong Excel/SQL skills, and a Bachelor's degree or equivalent experience.

Competenze

• 3 years minimum experience with government-regulated health programs within financial operations.
• Experience with Medicaid, Medicare, and/or exchanges is required or preferred.

Mansioni

• Review claims and PDE errors and analyze PDE Rejections.
• Distribute PDE Rejections reports to internal and external clients.
• Serve as liaison between PDE Reporting Team and other entities to ensure timely resolution.
• Coordinate research with departments and submit responses per CMS deadlines.
• Assist with weekly PDE meetings and CMS guidance review.
• Identify root causes of errors and recommend system or process improvements.
• Study CMS guidance to ensure compliance with CMS requirements.

Conoscenze

Communication skills

Organization

Time management

MS Word

Excel

Formazione

Bachelor's degree or equivalent work experience

Strumenti

SQL

Python

MS Word

Excel

Descrizione del lavoro

CVS Health in the United States seeks a full-time Claims Reviewer to analyze PDE errors and manage PDE Rejections for CMS compliance. The role includes distributing reports to clients, coordinating with the PDE Reporting Team, and ensuring timely resolutions.

Qualifications include 3+ years in government-regulated health programs within financial operations, strong Excel/SQL skills, and a Bachelor's degree or equivalent experience.