QA Analyst PBM Implementation - Remote

Prime Therapeutics; Salt Lake City (UT); Remote; USD 59,000 - 94,000; Full time

Job summary

A leading healthcare company is looking for a QA Analyst for PBM Implementation, working remotely. This role involves performing quality reviews, providing project support, and acting as a subject matter expert. Candidates should have a bachelor's degree and 2 years of relevant experience. The position offers competitive pay ranging from $59,000 to $94,000 based on experience.

Benefits

Comprehensive benefits package

Equal opportunity employer

Tobacco-Free Workplace

Qualifications

• 2 years of experience within Claims Processing, Audit, Quality or Pharmacy.
• Must be eligible to work in the United States without work visa.
• National Pharmacy Technician Certification if working in Pharmacy Audit.

Responsibilities

• Perform quality reviews and analysis of cases to prevent errors.
• Assist in gathering and documenting requirements for new system enhancements.
• Collaborate with trainers to provide feedback for training modules.

Skills

Organizational skills

Analytical skills

Communication skills

Time management skills

Interpersonal skills

Education

Bachelor's degree in Business, Liberal Arts, or related area

HS diploma or GED

Tools

Microsoft Excel

RxClaim

Job description

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

QA Analyst PBM Implementation - Remote

Job Description

The Quality Assurance (QA) Analyst performs complex quality reviews and serves as a subject matter expert and primary information resource for any escalated QA issues and questions. This role provides project support and feedback on implementations and reporting for QA-related activities.

Responsibilities

• Perform research and assist leadership in identification of potential missed turnaround times on review related to applicable quality tests
• Perform ongoing inter-rater reliability exercises and quality reviews for less tenured staff and provide performance feedback and information to identify areas of improvement
• Perform complex quality reviews and analysis of cases to prevent errors based on strict compliance, service level agreements, and regulatory guidance
• Discover outliers and areas of improvement on work product of reviewers; provide feedback for improvement to prevent quality issues
• Assist in the gathering, documenting, and implementations of requirements for new and future system enhancements
• Serve as liaison for directing unresolved issues for further evaluation and resolution
• Collaborate with trainers and writers to provide feedback for training modules and documentation
• Other duties as assigned

Minimum Qualifications

• Bachelor's degree in Business, Liberal Arts, or related area of study, or equivalent combination of education and/or related work experience; HS diploma or GED is required
• 2 years of experience within Claims Processing, Audit, Quality or Pharmacy
• Must be eligible to work in the United States without need for work visa or residency sponsorship
• If position sits within Clinical Review Department, the following qualifications are also required
• 1 year of experience as a Clinical Review Technician or 2 years of experience in Clinical Review
• If position sits within Pharmacy Audit department, the following qualifications are also required
• National Pharmacy Technician Certification through PTCB or ExCPT (CPhT)
• 2 years of experience working directly in a pharmacy

Additional Qualifications

• Strong organizational, analytical, interpretive, and time management skills
• Ability to make consistent and unbiased decisions
• Strong interpersonal, verbal and written communication skills
• Ability to provide work direction to others
• Ability to work under strict timelines while managing multiple priorities simultaneously
• Ability to analyze data using analytical tools (e.g. Microsoft Excel)

Preferred Qualifications

• National Pharmacy Technician Certification through PTCB or ExCPT (CPhT) or Licensed Practical Nurse certification if working in Medicare
• Healthcare, audit, and/or reporting and metrics environment experience
• Experience using RxClaim
• Experience in benefit design and review process for multiple clients
• PBM or healthcare experience

Potential pay for this position ranges from $59,000.00 - $94,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/benefits) and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics is a Tobacco-Free Workplace employer. If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email [e-mail].