Senior Medicare Claims & PDE Analyst

CVS Health; New York (NY); Hybride; USD 47 000 - 112 000; Plein temps

Avantages offerts par ce poste

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Résumé du poste

CVS Health is seeking a Claims/PDE Analyst to review Medicare PDE errors and manage PDE Rejections reports. You will coordinate with the PDE Reporting Team, Eligibility/Reconciliation, and other stakeholders to ensure timely, accurate resolution and CMS guidance compliance.

The role requires strong data analysis, SQL and Python proficiency, and clear communication with internal teams and external clients. A Bachelor’s degree is preferred with 3+ years in government-regulated health programs.

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.
• Proficiency with Microsoft Word and Excel.
• Proficiency with SQL and/or Python.

Responsabilités

• Review claims and PDE (Prescription Drug Event) errors and analyze PDE Rejections reports.
• Serve as liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation and all involved entities.
• Download and review the Acumen Outliers; coordinate research with various departments and submit responses per CMS deadlines.
• Assist with weekly PDE meetings and improve Medicare claims data through root cause and impact analysis of errors.

Connaissances

Communication

Time management

Organization

SQL

Python

Excel

Word

Formation

Bachelor's degree preferred or equivalent work experience

Outils

SQL

Python

Excel

Word

Description du poste

CVS Health is seeking a Claims/PDE Analyst to review Medicare PDE errors and manage PDE Rejections reports. You will coordinate with the PDE Reporting Team, Eligibility/Reconciliation, and other stakeholders to ensure timely, accurate resolution and CMS guidance compliance.

The role requires strong data analysis, SQL and Python proficiency, and clear communication with internal teams and external clients. A Bachelor’s degree is preferred with 3+ years in government-regulated health programs.