Senior Analyst, Financial Operations – PDE Reporting

This is a fully remote position, open to applicants in Alabama, +43 more states.

📋 Description

• Evaluate claims and Prescription Drug Event (PDE) discrepancies

• Analyze and distribute PDE Rejection reports and analyses to both internal and external stakeholders

• Act as a liaison between the PDE Reporting Team, PDE Eligibility/Reconciliation, and related entities

• Download and assess Acumen Outliers

• Coordinate investigations with various departments

• Submit responses to external clients or Acumen in accordance with CMS deadlines

• Support weekly PDE meetings

• Promote ongoing enhancement of Medicare claims data through root cause analysis and impact assessment of errors

• Suggest improvements to systems and procedures

• Review directives and ensure adherence to CMS regulations

⛳️ Requirements

• At least 3 years of experience with government-regulated health programs in financial operations and/or relevant experience, including Medicaid, Medicare, and/or Exchanges

• Familiarity with Part D plans

• Capacity to study and accurately interpret CMS Guidance

• Compliance with CMS regulations

• Exceptional written and verbal communication abilities

• Strong organizational skills with the capability to manage multiple projects at once

• Excellent time management skills

• Proficiency in Microsoft Word and Excel

• Proficiency in SQL and/or Python

• Bachelor's degree preferred or equivalent professional experience required

🏝️ Benefits

• Medical coverage

• Dental coverage

• Vision coverage

• Paid time off

• Retirement savings options

• Wellness programs

• Additional resources supporting physical, emotional, and financial well-being

• Eligibility for CVS Health bonus, commission, or short-term incentive programs