Pharmacy Quality Assurance Analyst

Job not on LinkedIn

October 10

🌽 Illinois – Remote

Although this job is listed in Illinois, this company may be open to hiring remote in other states.

💵 $75k - $90k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

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ZING. Enamel Whitening. Toothpaste, but magic.

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Beauty • Retail • Wellness

ZING is a toothpaste company that specializes in enamel whitening with a unique formulation that promises to dissolve stains, repair enamel, and reduce sensitivity. Proudly made in the UK, ZING's products are vegan, cruelty-free, and 100% recyclable. Their toothpaste is designed to be enjoyable to use while providing effective dental care, with a focus on natural ingredients and sustainability.

2 - 10 employees

Founded 2023

💄 Beauty

🛒 Retail

🧘 Wellness

📋 Description

• Evaluate current policies and procedures against CMS/NCQA requirements; identify gaps and recommend improvements. • Ensure system enhancements and implementations meet business and regulatory needs. • Develop and deliver training on new CMS/NCQA requirements; administer exams as needed. • Conduct internal and delegated audits; monitor pharmacy operations and recommend corrective actions. • Lead recovery efforts for COB, ESRD, Hospice, PDEs, LICs, P2P, and related processes. • Analyze claims and utilization data to ensure quality controls are in place. • Reconcile vendor invoices and resolve member/provider issues from Salesforce cases. • Support PDE management and error resolution processes. • Oversee FIR and COB backend reconciliation activities. • Manage monthly quality checks for marketing materials (print and web). • Perform monthly audits and exams across pharmacy units. • Present recommendations to improve system and process efficiency. • Conduct monthly internal audits and exams. • Coordinate audits of delegated entities and vendors. • Support CMS Financial, Operational, and NCQA audits. • Maintain audit samples and monitor performance metrics. • Manage annual updates to policies, procedures, and training logs. • Lead execution of the Pharmacy Internal Audit Plan (e.g., FIR/Nx Rejects, PDE Monitoring, MTM, Formulary Administration, Claims Processing). • Maintain and execute Corrective Action Plans and Compliance Issues Logs. • Facilitate monthly internal compliance meetings.

🎯 Requirements

• Preferred: Registered Pharmacy Technician & Certification • Education: Bachelor’s degree or 5+ years of healthcare experience • Strong analytical, mathematical, and problem-solving skills. • Experience with SQL data queries and report generation is a plus. • Excellent communication and interpersonal skills. • Bilingual (English/Spanish) preferred. • Experience With CVS Caremark PBM Reports. • Business intelligence and comparative analysis. • Project management and technical writing. • Ability to manage high-volume workloads professionally. • Strong teamwork and adaptability. • Proficiency in business modeling and object-oriented analysis. • Comfortable working flexible schedules (nights, weekends, holidays).

🏖️ Benefits

• Medical, Dental, and Vision • Employer-Paid Life Insurance • 401(K) match up to 4% • Paid-Time-Off • Several supplemental benefits are available, including, but not limited to, Spouse Insurance, Pet Insurance, Critical Illness coverage, ID Protection, etc.