Medicare PDE & Claims Integrity Analyst

CVS Health; Saint Paul (MN); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Job summary

CVS Health is seeking a detail-oriented claims analyst to review PDE errors and CMS guidance compliance. You will analyze PDE Rejections, coordinate with the PDE Reporting Team and related departments, and prepare responses for external clients within CMS deadlines.

The role requires 3+ years in government-regulated health programs, strong communication, and proficiency in SQL/Python, Word and Excel. Full-time in Minnesota, with a comprehensive benefits package.

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations and/or related experience (Medicaid, Medicare, and/or Exchanges).
• Bachelor's degree preferred or equivalent work experience required
• This role requires strong communication, organization and time-management skills.

Responsibilities

• Review claims and PDE (Prescription Drug Event) errors and analyze PDE Rejections reports.
• Coordinate research with multiple departments and respond to external clients per CMS deadlines.
• Assist with weekly PDE meetings and drive continuous improvement of Medicare claims data through root cause analysis.

Skills

Excellent written and verbal comunicat

Strong organizational skills

Time management

Education

Bachelor's degree or equivalent work experience

Tools

SQL

Python

Microsoft Word

Microsoft Excel

Job description

CVS Health is seeking a detail-oriented claims analyst to review PDE errors and CMS guidance compliance. You will analyze PDE Rejections, coordinate with the PDE Reporting Team and related departments, and prepare responses for external clients within CMS deadlines.

The role requires 3+ years in government-regulated health programs, strong communication, and proficiency in SQL/Python, Word and Excel. Full-time in Minnesota, with a comprehensive benefits package.