Medicare PDE & Claims Integrity Analyst

CVS Health; Athens (GA); On-site; USD 47,000 - 112,000; Full time

Job summary

CVS Health is seeking a claims reviewer to analyze PDE errors and coordinate research with multiple teams. You will review PDE rejections and ensure timely resolution in line with CMS deadlines.

This full-time role requires working knowledge of government programs (Medicare/Medicaid), strong communication, and proficiency with Word, Excel, and at least one of SQL or Python. You will participate in weekly PDE meetings and help improve Medicare claims data through root-cause analysis and system

Qualifications

• ~3 years minimum experience with government-regulated health programs within financial operations.
• Excellent written and verbal communication skills for interaction with clients, internal partners, and government agencies.
• Strong organizational skills and ability to manage multiple projects simultaneously.
• Excellent time management skills for time-sensitive requests.
• Proficiency with Microsoft Word and Excel.
• Proficiency with SQL and/or Python.

Responsibilities

• Review claims and PDE (Prescription Drug Event) errors and analyze PDE rejections.
• Coordinate research with departments and submit responses to external clients per CMS deadlines.
• Assist with weekly PDE meetings and ensure timely resolution of issues.
• Improve Medicare claims data through root cause and impact analysis of errors and recommend system and process enhancements.

Skills

Regulated health programs

Financial operations

Communication skills

Excel

SQL

Python

Education

Bachelor's degree or equivalent

Tools

Microsoft Word

Job description

CVS Health is seeking a claims reviewer to analyze PDE errors and coordinate research with multiple teams. You will review PDE rejections and ensure timely resolution in line with CMS deadlines.

This full-time role requires working knowledge of government programs (Medicare/Medicaid), strong communication, and proficiency with Word, Excel, and at least one of SQL or Python. You will participate in weekly PDE meetings and help improve Medicare claims data through root-cause analysis and system