Senior Medicare PDE & Claims Analyst

CVS Health; Pennsylvania; Hybride; USD 47 000 - 112 000; Plein temps

Avantages offerts par ce poste

Medical benefits

Dental benefits

Vision coverage

PTO

Retirement savings

Wellness programs

Résumé du poste

CVS Health is seeking a claims analyst to review PDE errors and related rejections, coordinating research with multiple departments and delivering timely responses to clients. The role emphasizes CMS guidance compliance and ongoing improvement of Medicare claims data.

The position requires 3+ years in government-regulated health programs, strong Excel, SQL, and Python skills, and a Bachelor's degree or equivalent experience. This full-time role offers comprehensive benefits.

Qualifications

• 3 years minimum experience with government-regulated health programs within financial operations and/or related experience (Medicaid, Medicare, and/or Exchanges).
• Excellent written and verbal communication skills for interaction with clients, internal partners, and government agencies.
• Strong organizational skills and ability to manage multiple projects simultaneously.
• Excellent time management skills as these requests are time sensitive.
• Proficiency with Microsoft Word and Excel.
• Proficiency with SQL and/or Python.

Responsabilités

• Review PDE errors and PDE Rejections and coordinate their resolution.
• Analyze the PDE Rejections reports and distribute findings to internal and external clients.
• Coordinate research with various departments and submit responses to external clients or Acumen according to CMS deadlines.
• Assist with the weekly PDE meetings.
• Ensure continuous improvement of Medicare claims data through root cause and impact analysis of errors, with recommendations for systems and procedure enhancements.
• Study CMS guidance and ensure compliance with CMS requirements.

Connaissances

Excel

Communication skills

Time management

Organizational skills

Formation

Bachelor's degree or equivalent

Outils

SQL

Python

Description du poste

CVS Health is seeking a claims analyst to review PDE errors and related rejections, coordinating research with multiple departments and delivering timely responses to clients. The role emphasizes CMS guidance compliance and ongoing improvement of Medicare claims data.

The position requires 3+ years in government-regulated health programs, strong Excel, SQL, and Python skills, and a Bachelor's degree or equivalent experience. This full-time role offers comprehensive benefits.