Medicare PDE & Claims Reconciliation Analyst

CVS Health; Bismarck (ND); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a full-time position in the United States to review claims and PDE (Prescription Drug Event) errors. The analyst will analyze PDE rejections, coordinate with the PDE Reporting Team and Eligibility/Reconciliation, and ensure timely resolutions in accordance with CMS deadlines.

The role requires knowledge of Part D plans and CMS guidance. The candidate should have at least 3 years of experience with government-regulated health programs and a Bachelor’s degree or equivalent

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

Responsibilities

• Review claims and PDE errors and analyze PDE rejections.
• Coordinate with PDE Reporting Team, PDE Eligibility/Reconciliation and all related entities to ensure timely resolution.
• Download and review Acumen Outliers and submit responses to external clients per CMS deadlines.
• Assist with weekly PDE meetings and drive continuous improvement of Medicare claims data.
• Study CMS guidance and ensure compliance with CMS requirements.

Skills

Word

Excel

SQL

Python

Education

Bachelor's degree preferred

Job description

CVS Health is seeking a full-time position in the United States to review claims and PDE (Prescription Drug Event) errors. The analyst will analyze PDE rejections, coordinate with the PDE Reporting Team and Eligibility/Reconciliation, and ensure timely resolutions in accordance with CMS deadlines.

The role requires knowledge of Part D plans and CMS guidance. The candidate should have at least 3 years of experience with government-regulated health programs and a Bachelor’s degree or equivalent