Pharmacy Quality Control & Credentialing Analyst

CVSHealth; Phoenix (AZ); On-site; USD 44,000 - 85,000; Full time

Benefits offered by this job

Comprehensive benefits

Medical/Dental/Vision coverage

Paid time off

Job summary

CVS Health in Phoenix, AZ, is seeking a Pharmacy Quality Control Analyst to ensure enrollment compliance, perform audit sampling, and support regulatory requests. You will interact with multiple stakeholders and contribute to SOX and URAC processes.

The role emphasizes independent thinking, accurate data validation, and the creation of tools and reports to improve QC workflows in a fast-paced PBM environment.

Qualifications

• 2+ years experience with credentialing and/ or auditing within a pharmacy/ medical setting.
• Must reside in Arizona.
• Strong knowledge of mainframe applications for pharmacy enrollment and claims processing for (Recap & RxClaim).
• Proficient in Microsoft Office - Excel, Word, and Access. Ability to perform detailed QC functions in a speedy, efficient, and accurate manner is critical.

Responsibilities

• Ensure SOX internal controls, SSAE-16 (SOC1) Reporting, and URAC accreditation for enrollment.
• Validate documentation and data accuracy for enrollment audits to mitigate impact and avoid corrective actions.
• Assess and respond to regulatory information requests related to credentialing and contracting.
• Develop and maintain QC tools and reports; coordinate cross-functional projects and SME support.

Skills

Credentialing/Auditing

Arizona resident

Mainframe applications (Recap, RxClaim

MS Office (Excel, Word, Access)

Education

High School Diploma or equivalent

Bachelor's degree or equivalent

Tools

Recap

RxClaim

Job description

CVS Health in Phoenix, AZ, is seeking a Pharmacy Quality Control Analyst to ensure enrollment compliance, perform audit sampling, and support regulatory requests. You will interact with multiple stakeholders and contribute to SOX and URAC processes.

The role emphasizes independent thinking, accurate data validation, and the creation of tools and reports to improve QC workflows in a fast-paced PBM environment.