Pharmacy QA & Compliance Analyst

Socket.dev; Illinois; On-site; USD 75,000 - 110,000; Full time

Job summary

Zing Health seeks a detail-oriented Pharmacy Quality Assurance Analyst to ensure operations meet CMS and NCQA standards. This role supports audits, process improvements, and regulatory compliance across pharmacy operations.

The position involves evaluating policies, conducting internal audits, and leading corrective actions. Strong analytical skills, SQL experience, and bilingual English/Spanish are highly valued.

Qualifications

• Bachelor’s degree or 5+ years of healthcare experience.
• Preferred: Registered Pharmacy Technician & Certification.
• Bilingual English/Spanish preferred.

Responsibilities

• 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.

Skills

Analytical skills

Math skills

Problem solving

Communication skills

Bilingual (English/Spanish)

CVS Caremark PBM reports

Business intelligence

Competitive analysis

Project management

Technical writing

Time management

Teamwork

OOA / business modeling

Education

Bachelor’s degree

Tools

Salesforce

SQL

Job description

Zing Health seeks a detail-oriented Pharmacy Quality Assurance Analyst to ensure operations meet CMS and NCQA standards. This role supports audits, process improvements, and regulatory compliance across pharmacy operations.

The position involves evaluating policies, conducting internal audits, and leading corrective actions. Strong analytical skills, SQL experience, and bilingual English/Spanish are highly valued.