Senior Medicare Claims & PDE Analyst

CVS Health; Colorado; Hybrid; USD 47,000 - 112,000; Full time

Benefits offered by this job

Comprehensive benefits package

Retirement savings options

Wellness programs

Job summary

CVS Health is hiring for a role focused on reviewing claims and PDE errors, coordinating research, and ensuring timely resolution of PDE rejections. The position involves liaising with the PDE Reporting Team, Eligibility/Reconciliation, and other stakeholders to meet CMS deadlines.

The candidate should have working knowledge of Part D plans and CMS guidance, with strong communication and organizational skills to manage multiple projects in a fast-paced environment.

Qualifications

• Bachelor's degree preferred or equivalent work experience.
• 3 years minimum experience with government-regulated health programs within financial operations and/or related experience (Medicaid, Medicare, and/or Exchanges).
• Strong communication skills for interaction with clients, internal partners, and government agencies.

Responsibilities

• Review claims and PDE (Prescription Drug Event) errors and analyze PDE Rejections.
• Distribute PDE Rejections reports and coordinate responses to internal and external clients.
• Serve as liaison between PDE Reporting Team, PDE Eligibility/Reconciliation and other entities to ensure timely resolution of PDE Rejections.
• Assist with weekly PDE meetings and drive continuous improvement of Medicare claims data through root cause analysis.

Skills

Communication

Organization

Time management

MS Word & Excel

SQL

Python

Education

Bachelor's degree preferred or equivalent

Tools

Microsoft Excel

Job description

CVS Health is hiring for a role focused on reviewing claims and PDE errors, coordinating research, and ensuring timely resolution of PDE rejections. The position involves liaising with the PDE Reporting Team, Eligibility/Reconciliation, and other stakeholders to meet CMS deadlines.

The candidate should have working knowledge of Part D plans and CMS guidance, with strong communication and organizational skills to manage multiple projects in a fast-paced environment.