Senior Analyst, Financial Operations – PDE Reporting
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Job Description
Senior Analyst reviewing Medicare PDE claims errors and CMS reporting for CVS Health. Analyzing rejections, coordinating resolutions, and improving Medicare claims data quality.
Responsibilities:
- Review claims and PDE (Prescription Drug Event) errors
- Analyze and distribute PDE Rejections reports and analysis to internal and external clients
- Serve as liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation, and entities involved with PDE
- Download and review Acumen Outliers
- Coordinate research with various departments
- Submit responses to external clients or Acumen according to CMS deadlines
- Assist with weekly PDE meetings
- Ensure continuous improvement of Medicare claims data through root cause and impact analysis of errors
- Recommend systems and procedure enhancements
- Review guidance and ensure compliance with CMS
Requirements:
- Minimum 3 years of experience with government-regulated health programs within financial operations and/or related experience, including Medicaid, Medicare, and/or Exchanges
- Working knowledge of Part D plans
- Ability to study and correctly interpret CMS Guidance
- Compliance with CMS guidance
- Excellent written and verbal communication skills
- Strong organizational skills and ability to manage multiple projects simultaneously
- Excellent time management skills
- Proficiency with Microsoft Word and Excel
- Proficiency with SQL and/or Python
- Bachelor's degree preferred or equivalent work experience required
Benefits:
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- CVS Health bonus, commission or short-term incentive program eligibility
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