Pharmacy QA Analyst — CMS/NCQA Compliance

Zing Health, Inc.; Alton (IL); Sur place; USD 90 000 - 130 000; Plein temps

Résumé du poste

Zing Health, Inc. is seeking a detail-oriented Pharmacy Quality Assurance Analyst to ensure Pharmacy Operations align with CMS and NCQA standards. You will drive compliance, audits, and process improvements while supporting internal and external reviews.

The role includes developing CMS/NCQA training, analyzing claims data for quality controls, and coordinating reconciliations and audits across pharmacy units. Bilingual English/Spanish is preferred; evenings or weekends may be required.

Qualifications

• Detail-oriented QA Analyst with CMS/NCQA knowledge.
• Experience auditing and ensuring compliance with regulatory standards.
• Ability to develop training on CMS/NCQA requirements.

Responsabilités

• Evaluate current policies and procedures against CMS/NCQA requirements.
• Develop and deliver training on CMS/NCQA requirements; monitor 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.
• Reconcile vendor invoices and resolve member/provider issues from Salesforce cases.
• 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.
• 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.

Connaissances

Attention to detail

CMS/NCQA knowledge

Training & instruction

Data analysis

Vendor management

Audit management

Project management

Technical writing

BI analysis

SQL data queries

Bilingual (English/Spanish)

Object-oriented analysis

Formation

Bachelor's degree

Outils

SQL

Salesforce

Description du poste

Zing Health, Inc. is seeking a detail-oriented Pharmacy Quality Assurance Analyst to ensure Pharmacy Operations align with CMS and NCQA standards. You will drive compliance, audits, and process improvements while supporting internal and external reviews.

The role includes developing CMS/NCQA training, analyzing claims data for quality controls, and coordinating reconciliations and audits across pharmacy units. Bilingual English/Spanish is preferred; evenings or weekends may be required.