Pharmacy QA & Compliance Analyst – Audits & Regulation

Zing Health; Illinois; On-site; USD 85,000 - 110,000; Full time

Job summary

Zing Health, a tech-enabled Medicare Advantage company based in Illinois, seeks a detail-oriented Pharmacy Quality Assurance Analyst to ensure operations align with CMS/NCQA standards. You will lead audits, improve processes, and support regulatory reporting and training.

Responsibilities include evaluating policies, conducting internal audits, reconciling data, and collaborating with care teams to maintain quality controls. Strong analytical skills and SQL experience are essential.

Qualifications

• 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).

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.
• Coordinate audits of delegated entities and vendors.
• Support CMS Financial, Operational, and NCQA audits.

Skills

Analytical skills

Problem solving

SQL data queries

Reporting & BI

Communication

Bilingual English/Spanish

CVS Caremark PBM Reports

Business intelligence

Project management

Technical writing

Teamwork & adaptability

Time management

Education

Bachelor’s degree

Healthcare experience 5+ years

Tools

SQL

PBM reporting tools

Job description

Zing Health, a tech-enabled Medicare Advantage company based in Illinois, seeks a detail-oriented Pharmacy Quality Assurance Analyst to ensure operations align with CMS/NCQA standards. You will lead audits, improve processes, and support regulatory reporting and training.

Responsibilities include evaluating policies, conducting internal audits, reconciling data, and collaborating with care teams to maintain quality controls. Strong analytical skills and SQL experience are essential.