Medicare PDE & Claims Reconciliation Analyst

CVS Health; Clifton (TX); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a dedicated professional to review claims and PDE errors, acting as a liaison across PDE teams and external clients. You will analyze PDE Rejections, coordinate with departments to meet CMS deadlines, and participate in weekly PDE meetings to improve Medicare data quality.

Ideal candidates have ~3 years in government-regulated health programs, with strong communication skills and experience in Word/Excel; SQL/Python proficiency is a plus.

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations or related experience.
• Experience with Medicaid, Medicare, or Exchanges is preferred.
• Proficiency with Word and Excel; SQL/Python skills are a plus.

Responsibilities

• Review claims and PDE (Prescription Drug Event) errors and analyzes PDE Rejections.
• Coordinate research with multiple departments and respond to external clients per CMS deadlines.
• Support weekly PDE meetings and drive continuous improvement of Medicare claims data.
• Understand Part D concepts and CMS guidance to ensure regulatory compliance.

Skills

Excellent written and verbal comms

Strong organizational skills

Time management

Education

Bachelor's degree preferred or equivalent work experience

Tools

SQL

Python

Microsoft Word

Excel

Job description

CVS Health is seeking a dedicated professional to review claims and PDE errors, acting as a liaison across PDE teams and external clients. You will analyze PDE Rejections, coordinate with departments to meet CMS deadlines, and participate in weekly PDE meetings to improve Medicare data quality.

Ideal candidates have ~3 years in government-regulated health programs, with strong communication skills and experience in Word/Excel; SQL/Python proficiency is a plus.