ZING. Enamel Whitening. Toothpaste, but magic.

Risk

• Build and automate reports using Python, SQL, Excel, etc.
• Analyze large and small datasets: join, transform, engineer features, and extract insights.
• Performs research and deep-dive analysis of complex healthcare claims data, CMS return files, and financial cost, revenue, and vendor data.
• Use the CMS risk adjustment model to support revenue accruals.
• Optimize Medicare Advantage audit outcomes using statistical techniques.
• Create tools and dashboards that improve operational efficiency.

Risk Adjustment Analyst

Manager

• Manage physician contracting and network development for an assigned region
• Develop and maintain cooperative working relationships with the provider community
• Educate, train, research issues, and identify trends
• Evaluate providers to ensure contractual and financial requirements are adhered to
• Contracts and negotiates with Hospital, FQHCs, Physicians and Ancillary providers for all product lines
• Conduct Provider Orientations and ongoing education to Network Providers
• Understand and explain fee-for-service and risk contracts
• Respond to provider’s contract requests and inquiries
• Analyze network gaps and identify providers to contract
• Review and amend provider’s contracts when necessary
• Evaluate contracted network to ensure functionality
• Research and develop relationships with non-contracted providers
• Collect credentialing and required documents for newly contracted providers
• Perform special projects as assigned

Provider Contracting Manager

QA Engineer

• 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.

Pharmacy Quality Assurance Analyst

Customer Support

• Support day-to-day broker inquiries, via email and telephonically, to support broker satisfaction to help Zing become known as the easiest plan to do business with from a broker perspective.
• Collaborate within the Broker Support team to support the long-term strategy and vision for the broker support function, including the right tools/processes needed, communication trends, specialization and resolution aids, and best practices.
• Partner closely with Zing Partner Sales groups, which drive broker sales to ensure holistic synergies exist between those Growth functions and expectations can be delivered on with Zing’s broker partners.

Risk Adjustment Analyst

Provider Contracting Manager

Pharmacy Quality Assurance Analyst

Sales & Broker Support Specialist