Pharmacy Quality & Credentialing Analyst

CVS Health Corporation; Phoenix, Northern (AZ, KY); Hybrid; USD 44,000 - 85,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus eligibility

Job summary

CVS Health Corporation in Arizona is seeking a Pharmacy Quality Control Analyst to ensure timely and accurate delivery of enrollment compliance, audit sampling, and regulatory support. You will enforce and administer quality control for pharmacy provider enrollment, credentialing, and contract audit processes.

You will support legal and regulatory RFIs related to credentialing and contracting, and develop tools/reports to improve control and efficiency.

Qualifications

• 2+ years experience with credentialing and/or auditing in a pharmacy/medical setting.
• Must reside in Arizona.
• Proficient with mainframe applications for pharmacy enrollment and claims processing (Recap, RxClaim).
• Proficient with Microsoft Office (Excel, Word, Access).

Responsibilities

• Quality Control Pharmacy Provider Network: ensure enrollment compliance per SOX, SOC1 reporting, and URAC accreditation.
• Credentialing & Contract Audit fulfillment: compile audit sampling documentation and interpret scope.
• Legal & Regulatory Requests for Information (RFI) related to Credentialing & Contracting: assess requests to supply correct documentation.
• Interface with internal partners and manage communication across multi-level audiences.

Skills

Credentialing & Auditing

MS Office

Attention to detail

Education

High School Diploma or equivalent

Bachelor's degree or equivalent

Tools

Recap

RxClaim

SharePoint

Mainframe applications

Job description

CVS Health Corporation in Arizona is seeking a Pharmacy Quality Control Analyst to ensure timely and accurate delivery of enrollment compliance, audit sampling, and regulatory support. You will enforce and administer quality control for pharmacy provider enrollment, credentialing, and contract audit processes.

You will support legal and regulatory RFIs related to credentialing and contracting, and develop tools/reports to improve control and efficiency.