Note: The job is a remote job and is open to candidates in USA. CVS Health is hiring a Senior Analyst to review claims and prescription drug event (PDE) errors and support accurate, timely resolution of PDE rejections. The role coordinates research and reporting with internal and external stakeholders, ensures compliance with CMS guidance, and drives improvements to Medicare claims data.
Responsibilities
- This position is responsible for reviewing claims and PDE (Prescription Drug Event) errors
- This includes analyzing and distributing the PDE Rejections reports and analysis to internal and external clients
- The position will serve as liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation and all entities involved directly or indirectly with PDE to ensure timely and accurate resolution of PDE Rejections
- Download and review the Acumen Outliers
- Coordinate the research with various departments and submit the 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, recommendations for systems and procedure enhancements
- The position will rely upon business knowledge, including industry concepts and practices, technical skills, and prior experience to plan and accomplish goals
- Candidate should have working knowledge of Part D plans and be able to study and correctly interpret CMS Guidance
- This position is also responsible for review of guidance and being compliant with CMS
Skills
- 3 years minimum experience with government-regulated health programs within financial operations and/or related experience (Medicaid, Medicare, and/or Exchanges)
- 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
- Equivalent work experience required
- Excellent written and verbal communication skills for interaction with clients, internal partners, and government agencies
- Proficiency with SQL and/or Python
- Bachelor's degree preferred
Benefits
- Eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
- This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
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