Senior Medicare PDE & Claims Analyst

CVS Health; California City (CA); Presencial; USD 47.000 - 112.000; Tempo integral

Resumo da vaga

CVS Health is seeking a detail-oriented professional to review claims and PDE errors, coordinating responses with internal teams and external clients to meet CMS deadlines. The role supports continuous improvement of Medicare data through root cause analysis and collaboration with the PDE Reporting Team.

The candidate will liaise with various departments, review Acumen Outliers, and ensure adherence to CMS guidance while maintaining high-quality data and timely communications.

Qualificações

• 3 years minimum experience with government-regulated health programs.
• Experience with Medicaid, Medicare, and/or Exchanges.
• Experience in financial operations.

Responsabilidades

• Review claims and PDE errors and analyze PDE Rejections.
• Serve as liaison between PDE Reporting Team, PDE Eligibility/Reconciliation and related entities.
• Coordinate research with departments and respond to external clients or Acumen per CMS deadlines.
• Assist with weekly PDE meetings and ensure timely resolutions.
• Perform root cause analysis to improve Medicare claims data and recommend system/process enhancements.
• Study CMS guidance and ensure compliance with CMS requirements.

Conhecimentos

Government-regulated health programs

Financial operations

Medicaid

Medicare

Exchanges

SQL

Python

Microsoft Word

Excel

Communication skills

Organizational skills

Time management

Formação

Bachelor's degree or equivalent work experience

Ferramentas

SQL

Descrição da vaga

CVS Health is seeking a detail-oriented professional to review claims and PDE errors, coordinating responses with internal teams and external clients to meet CMS deadlines. The role supports continuous improvement of Medicare data through root cause analysis and collaboration with the PDE Reporting Team.

The candidate will liaise with various departments, review Acumen Outliers, and ensure adherence to CMS guidance while maintaining high-quality data and timely communications.