Pharmacy Credentialing & Audit Quality Analyst

7505 Caremark, L.L.C.; Scottsdale (AZ); On-site; USD 44,000 - 85,000; Full time

Benefits offered by this job

Bonus eligibility

Job summary

CVS Health is seeking a Pharmacy Quality Control Analyst to ensure enrollment compliance, prepare audit samples, and respond to regulatory requests within a fast-paced environment. The role emphasizes data accuracy, SOX controls, and URAC accreditation requirements.

Responsibilities include coordinating with internal partners, analyzing enrollment documentation, and maintaining quality review tools to prevent errors and support client needs.

Qualifications

• 2+ years experience with credentialing and/or auditing within a pharmacy/medical setting.
• Must reside in Arizona.
• Strong knowledge of mainframe applications for pharmacy enrollment and claims processing (Recap, RxClaim).
• Proficient in Microsoft Office - Excel, Word, and Access.

Responsibilities

• Quality Control Pharmacy Provider Network: ensure enrollment compliance with SOX internal controls, URAC accreditation, and related audits.
• Credentialing & Contract Audit fulfillment: compile audit sampling documentation and interpret audit scope.
• Regulatory Requests: assess and respond to RFIs for credentialing and contracting.
• Collaborate with internal partners and lead cross-functional task groups.
• Support legal/regulatory investigations by providing accurate documentation.

Skills

Credentialing

Auditing

Mainframe knowledge

Excel

Arizona resident

Education

Bachelor's degree

High School Diploma or equivalent

Job description

CVS Health is seeking a Pharmacy Quality Control Analyst to ensure enrollment compliance, prepare audit samples, and respond to regulatory requests within a fast-paced environment. The role emphasizes data accuracy, SOX controls, and URAC accreditation requirements.

Responsibilities include coordinating with internal partners, analyzing enrollment documentation, and maintaining quality review tools to prevent errors and support client needs.