Senior Medicare PDE & Claims Analyst

CVS Health; Columbia (SC); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical benefits

Dental & Vision

Paid time off

Retirement plan

Wellness programs

Job summary

CVS Health is seeking a detail-oriented professional to review and resolve PDE (Prescription Drug Event) errors and related CMS guidance for government-regulated health programs. You will coordinate with the PDE Reporting Team and Eligibility/Reconciliation groups to ensure timely resolutions and consistent data quality.

The role requires strong communication, organizational and time-management skills, plus proficiency with Excel/Word and some SQL/Python.

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations.
• Ability to study and interpret CMS guidance.
• Experience with reviewing PDE Rejections and related CMS outcomes.

Responsibilities

• Review claims and PDE (Prescription Drug Event) errors and analyses.
• Distribute PDE Rejections reports to internal and external clients.
• Coordinate research with departments and respond to external clients per CMS deadlines.
• Assist with weekly PDE meetings and ensure timely resolution of PDE Rejections.
• Improve Medicare claims data through root cause analysis and system/process enhancements.

Skills

Communication

Organizational skills

Time management

SQL

Python

Microsoft Word

Microsoft Excel

Education

Bachelor's degree preferred

Tools

SQL

Python

Microsoft Word

Microsoft Excel

Job description

CVS Health is seeking a detail-oriented professional to review and resolve PDE (Prescription Drug Event) errors and related CMS guidance for government-regulated health programs. You will coordinate with the PDE Reporting Team and Eligibility/Reconciliation groups to ensure timely resolutions and consistent data quality.

The role requires strong communication, organizational and time-management skills, plus proficiency with Excel/Word and some SQL/Python.