Pharmacy QA & Compliance Analyst — CMS/NCQA Audits

Zing Health, Inc.; Springfield (IL); On-site; USD 75,000 - 110,000; Full time

Job summary

Zing Health, Inc. is seeking a detail-oriented Pharmacy Quality Assurance Analyst to ensure Pharmacy Operations meet CMS and NCQA standards, audits, and process improvements. This role emphasizes collaboration and regulatory excellence within a Medicare Advantage framework.

You will coordinate audits, training on CMS/NCQA requirements, and vendor oversight while supporting accurate data analysis, reconciliation, and cross-functional cooperation to uphold quality and patient safety.

Qualifications

• Bachelor’s degree or 5+ years healthcare experience is required or preferred.
• Experience with CMS and NCQA audits is a plus.
• 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.

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

SQL queries

Communication skills

Bilingual (English/Spanish)

Teamwork

Problem solving

Project management

Technical writing

OO analysis

Education

Bachelor’s degree or 5+ years healthcare experience

Job description

Zing Health, Inc. is seeking a detail-oriented Pharmacy Quality Assurance Analyst to ensure Pharmacy Operations meet CMS and NCQA standards, audits, and process improvements. This role emphasizes collaboration and regulatory excellence within a Medicare Advantage framework.

You will coordinate audits, training on CMS/NCQA requirements, and vendor oversight while supporting accurate data analysis, reconciliation, and cross-functional cooperation to uphold quality and patient safety.