Quality Analyst II

MedImpact Healthcare Systems, Inc.•San Diego, CA

4d•$29 - $48•Onsite

About The Position

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team! Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare. At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution! Job Description Summary Participates in the execution of an effective quality assurance program to ensure that the operational component of MedImpact’s PBM programs and services meet client requirements and government regulations. Works under general supervision with a limited degree of independence.

Requirements

BS/BA and 3+ years’ experience or equivalent combination of education and experience
Previous experience writing SQL queries, Automation Testing, File Transfer Protocol and UNIX is highly desirable.
Intermediate to advanced skills in Microsoft Office with an emphasis on Word, Excel, MS Access and Project.
Intermediate to advanced skills in SQL queries.
Knowledge of Quality Assurance methodologies and practical application.
Ability to research, assess, audit, and apply information to practices and standards.
Strong analytical and problem solving ability and in-depth understanding of PBM regulations and related CMS guidance
Demonstrated ability to work in a fast paced environment, learn quickly, appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment.
Demonstrate ability to meet or exceed the competencies as listed.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
Ability to deal with problems involving several concrete variables in standardized situations.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Ability to write reports, business correspondence, and procedure manuals.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
To perform the job successfully, an individual should demonstrate the following competencies: Composure Decision Quality Organizational Agility Problem Solving Customer Focus Drive for Results Peer Relations Time Management Dealing with Ambiguity Learning on the Fly Political Savvy
While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.
This position must work on-site at the San Diego Headquarters for purposes of providing adequate support to internal clients; being available for face-to-face interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as for facilitation of quick and effective decisions through collaboration with stakeholders. Remote work is not an option for these purposes.
This is a full-time non-exempt position requiring one to be able to work overtime from time to time in order to get the job done. Therefore, one must have the ability to work nights, weekends or on holidays as required.

Nice To Haves

Healthcare, Managed Care, Government Programs or PBM Quality experience is preferred

Responsibilities

Develop and execute department's quality assurance procedures and participate in quality improvement initiatives.
Ensure that deliverables are on time and meet the quality levels expected by Medlmpact's internal and external customers and the Centers for Medicare and Medicaid Services (CMS).
Understanding of PBM regulations and related CMS guidance.
Responsible for proactive review of all CMS regulation and guidance.
Provides assessment of requirements when CMS revises guidelines and implements quality and compliance monitoring changes to ensure compliance to new guidelines.
Understanding of quality methodologies, practices and techniques.
Execute and track quality and compliance review projects.
Develop quality review procedures, perform tests and document test results.
Participate in evaluations and audits of PBM services provided by Medlmpact.
Implement corrective action plans in response to negative findings
Test multiple files with high volumes of data
Interface with internal operational areas and with external customers to improve the quality of customers' implementation of the PBM program. Areas include Part D Benefit Setup, Part D Pharmacy Network Setup, CMS Plan Finder Submissions, Member Part D Explanation of Benefit Statements, CMS Reporting, Prescription Drug Event Reporting, Part D Policy and Procedures, and other PBM services provided by Medlmpact
Respond to inquiries from internal and external customers regarding quality review and compliance policy and procedures.
Implement corrective action plans in response to negative findings.
Keep management team updated on significant issues or developments identified during quality control activities and actions being taken to improve the situation.