Senior Analyst, Financial Operations - PDE Reporting

CVS Health • Washington, NV

2d • $46,988 - $112,200

About The Position

This position reviews claims and Prescription Drug Event (PDE) errors, analyzes and distributes PDE Rejections reports and analysis to internal and external clients, and serves as a liaison among the PDE Reporting Team, PDE Eligibility/Reconciliation, and entities involved with PDE to help ensure timely and accurate resolution of rejections. The role downloads and reviews Acumen Outliers, coordinates research with various departments, and submits responses to external clients or Acumen according to CMS deadlines. It also assists with weekly PDE meetings and supports continuous improvement of Medicare claims data through root cause and impact analysis of errors and recommendations for systems and procedural enhancements. The position relies on business knowledge, industry concepts and practices, technical skills, and prior experience to plan and accomplish goals. The candidate should have working knowledge of Part D plans, be able to study and correctly interpret CMS guidance, and review guidance to ensure compliance with CMS.

Requirements

• At least 3 years of experience with government-regulated health programs within financial operations and/or related experience, such as Medicaid, Medicare, and/or Exchanges.
• Working knowledge of Part D plans.
• Ability to study and correctly interpret CMS guidance.
• Bachelor's degree preferred, or equivalent work experience required.

Nice To Haves

• 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 for handling time-sensitive requests.
• Proficiency with Microsoft Word and Excel.
• Proficiency with SQL and/or Python.

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 directly or indirectly with PDE to support timely and accurate resolution of PDE Rejections.
• Download and review Acumen Outliers.
• Coordinate research with various departments and submit responses to external clients or Acumen according to CMS deadlines.
• Assist with weekly PDE meetings.
• Conduct root cause and impact analysis of errors and recommend systems and procedure enhancements to improve Medicare claims data.
• Review guidance and ensure compliance with CMS.

Benefits

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources based on eligibility.
• Eligible for a CVS Health bonus, commission, or short-term incentive program in addition to base pay.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior