Pharmacy Quality Assurance & Compliance Analyst

Zing Health, Inc.; Berwyn (IL); On-site; USD 80,000 - 90,000; 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. This role focuses on compliance, process improvements, audits, and training.

Responsibilities include evaluating policies, performing audits, managing invoices, analyzing claims data, and supporting PDE management. The position requires strong analytical and communication skills, experience with SQL, and ability to work nights/weekends as needed to support

Qualifications

• Bachelor's degree or 5+ years of healthcare experience.

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.
• 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.

Skills

Analytical skills

Communication skills

Bilingual English/Spanish

Teamwork

Problem solving

SQL knowledge

Technical writing

Flexibility

Time management

Education

Bachelor's degree

Healthcare experience (5+ years)

Tools

SQL

Reports generation

Job description

Zing Health, Inc. is seeking a detail-oriented Pharmacy Quality Assurance Analyst to ensure Pharmacy Operations meet CMS and NCQA standards. This role focuses on compliance, process improvements, audits, and training.

Responsibilities include evaluating policies, performing audits, managing invoices, analyzing claims data, and supporting PDE management. The position requires strong analytical and communication skills, experience with SQL, and ability to work nights/weekends as needed to support