Pharmacy QA Analyst: Compliance & Audit Focus

Zing Health Holdings Inc; Illinois; Presencial; USD 70.000 - 110.000; Jornada completa

Descripción de la vacante

Zing Health Holdings Inc. is seeking a detail-oriented Pharmacy Quality Assurance Analyst to ensure Pharmacy Operations align with CMS and NCQA standards. You will evaluate policies, develop training, monitor HIPAA-related processes, and lead audits across COB, ESRD, PDEs, LICs, and MTM.

Strong SQL/reporting skills and bilingual English/Spanish are preferred. Join a team dedicated to regulatory compliance, continuous process improvement, and accurate auditing of vendor invoices, marketing

Formación

• Evaluate CMS/NCQA requirements and ensure system enhancements meet business and regulatory needs.
• Develop and deliver training on CMS/NCQA requirements; 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.
• 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 (e.g., FIR/Nx Rejects, PDE Monitoring, MTM, Formulary Administration, Claims Processing).
• Experience with SQL data queries and report generation is a plus.

Responsabilidades

• Evaluate current policies and procedures against CMS/NCQA requirements.
• Develop and deliver training on new CMS/NCQA requirements; 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.
• 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.

Conocimientos

SQL queries

Report generation

BI analysis

Project management

Technical writing

Object-oriented analysis

Bilingual EN/ES

Educación

Bachelor’s degree

Pharmacy Technician Certification

Herramientas

Salesforce

Descripción del empleo

Zing Health Holdings Inc. is seeking a detail-oriented Pharmacy Quality Assurance Analyst to ensure Pharmacy Operations align with CMS and NCQA standards. You will evaluate policies, develop training, monitor HIPAA-related processes, and lead audits across COB, ESRD, PDEs, LICs, and MTM.

Strong SQL/reporting skills and bilingual English/Spanish are preferred. Join a team dedicated to regulatory compliance, continuous process improvement, and accurate auditing of vendor invoices, marketing