Job Description:
• 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