Senior Medicare Claims & PDE Analyst

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

Benefits offered by this job

Medical, dental, and vision coverage

Retirement savings options

Paid time off

Job summary

CVS Health in Washington state is seeking a claims and PDE reviewer to analyze and resolve PDE rejections and related errors. This role serves as a liaison between the PDE Reporting Team, Eligibility/Reconciliation, and other departments to ensure timely, accurate responses to CMS deadlines.

You will review Acumen Outliers, coordinate research with internal teams, and support weekly PDE meetings while driving continuous improvement in Medicare claims data through root-cause analysis and process

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 Word and Excel.

Responsibilities

• Review claims and PDE errors and analyze PDE Rejections reports for internal and external clients.
• Serve as liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation and other entities involved with PDE.
• Coordinate research with various departments and submit responses to CMS deadlines.
• Assist with weekly PDE meetings and drive continuous improvement of Medicare claims data through root cause analysis.

Skills

Communication skills

Time management

Organizational skills

Microsoft Word

Education

Bachelor's degree preferred or equivalent work experience

Tools

Excel

SQL

Python

Microsoft Word

Job description

CVS Health in Washington state is seeking a claims and PDE reviewer to analyze and resolve PDE rejections and related errors. This role serves as a liaison between the PDE Reporting Team, Eligibility/Reconciliation, and other departments to ensure timely, accurate responses to CMS deadlines.

You will review Acumen Outliers, coordinate research with internal teams, and support weekly PDE meetings while driving continuous improvement in Medicare claims data through root-cause analysis and process