QA Manager – Engineering
Brillio
AWSCloudCypressSelenium
Pharmacy Quality Assurance Analyst
ZING. Enamel Whitening. Toothpaste, but magic.
full-time
Posted on:
Location Type: Remote
Location: Remote • Illinois • 🇺🇸 United States
Visit company websiteSalary
💰 $75,000 - $90,000 per year
Job Level
Mid-LevelSenior
Tech Stack
SQL
About the role
- 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.
Requirements
- Preferred: Registered Pharmacy Technician & Certification
- Education: Bachelor’s degree or 5+ years of healthcare experience
- Strong analytical, mathematical, and problem-solving skills.
- Experience with SQL data queries and report generation is a plus.
- Excellent communication and interpersonal skills.
- Bilingual (English/Spanish) preferred.
- 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.
- Comfortable working flexible schedules (nights, weekends, holidays).
Benefits
- Medical, Dental, and Vision
- Employer-Paid Life Insurance
- 401(K) match up to 4%
- Paid-Time-Off
- Several supplemental benefits are available, including, but not limited to, Spouse Insurance, Pet Insurance, Critical Illness coverage, ID Protection, etc.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
SQLdata queriesreport generationbusiness modelingobject-oriented analysisanalytical skillsmathematical skillsproblem-solving skillsproject managementtechnical writing
Soft skills
communication skillsinterpersonal skillsteamworkadaptabilityability to manage high-volume workloadsstrong analytical skills
Certifications
Registered Pharmacy Technician Certification
