Pharmacy Quality Assurance Analyst

Zing Health Holdings Inc; Alton (IL); On-site; USD 75,000 - 95,000; Full time

Job summary

Zing Health Holdings Inc. in Illinois is seeking a detail-oriented Pharmacy Quality Assurance Analyst to ensure operations align with CMS and NCQA standards.

You will lead audits, analyze data, and drive process improvements to maintain regulatory compliance and support enterprise audits. The role requires strong analytical skills, experience with SQL and PBM reports, and the ability to manage high-volume workloads.

Qualifications

• Bachelor’s degree or 5+ years of healthcare experience.
• Strong analytical, mathematical and problem-solving skills.
• Experience with SQL queries and report generation.
• 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 abilities.
• Ability to manage high-volume workloads professionally.
• Teamwork and adaptability in a fast-paced environment.
• Proficiency in business modeling and object-oriented analysis.
• Flexible schedules (nights, weekends, holidays).

Responsibilities

• Evaluate policies 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

Bilingual

PBM Reports

BI & analysis

Project management

Technical writing

Workload management

Teamwork

OOA / modeling

Flexible schedule

Education

Bachelor's degree

Job description

Description

COMPANY OVERVIEW

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the healthcare equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs, and a dedicated care team. For more information on Zing Health, visit

SUMMARY DESCRIPTION:

A detail-oriented and experienced Pharmacy Quality Assurance Analyst to ensure Pharmacy Operations align with regulatory standards set by CMS and NCQA. This role is critical in maintaining compliance, driving process improvements, and supporting internal and external audits.

ESSENTIAL FUNCTIONS:

• 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.

Compliance & Audit Duties:

• Conduct monthly internal audits and exams.
• Coordinate audits of delegated entities and vendors.
• 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).
• Maintain and execute Corrective Action Plans and Compliance Issues Logs.
• Facilitate monthly internal compliance meetings.

Requirements

QUALIFICATIONS AND REQUIREMENTS:

JOB REQUIREMENTS:

Preferred: Registered Pharmacy Technician & Certification

Education: Bachelor’s degree or 5+ years of healthcare experience.

Skills & Competencies:

• 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).

Mathematical & Reasoning Abilities:

• Proficient in calculating percentages, ratios, and interpreting graphs.
• Able to solve practical problems and interpret varied instructions.