Pharmacy Quality Assurance Analyst

Zing Health•Remote, IL

6d•$80,000 - $90,000

About The Position

Zing Health is a tech-enabled insurance company focused on improving Medicare Advantage for individuals aged 65 and over. They emphasize a community-based approach, recognizing the social determinants of health. Zing Health aims to place the physician and member at the core of healthcare, offering personalized plans, specialized facilities, and dedicated care teams. The Pharmacy Quality Assurance Analyst will ensure Pharmacy Operations comply with CMS and NCQA regulatory standards, focusing on compliance, process improvements, and audit support.

Requirements

Bachelor’s degree or 5+ years of healthcare experience.
Strong analytical, mathematical, and problem-solving skills.
Excellent communication and interpersonal skills.
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.
Proficient in calculating percentages, ratios, and interpreting graphs.
Able to solve practical problems and interpret varied instructions.

Nice To Haves

Registered Pharmacy Technician & Certification
Experience with SQL data queries and report generation
Bilingual (English/Spanish)
Comfortable working flexible schedules (nights, weekends, holidays).

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.