Pharmacy Quality Assurance Analyst
About the role
Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the healthcare equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs, and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.
A detail-oriented and experienced Pharmacy Quality Assurance Analyst to ensure Pharmacy Operations align with regulatory standards set by CMS and NCQA. This role is critical in maintaining compliance, driving process improvements, and supporting internal and external audits.
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