MedImpact Healthcare Systems, Inc.

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Quality Analyst I

at MedImpact Healthcare Systems, Inc.

Posted: 10/26/2019
Job Reference #: 5927

Job Description

Location:
San Diego, CA
 
Remote Location:


# of openings:
2
 
Department:


Employment duration:
Full time
 
Exemption Status:
Non-Exempt

Relocation Assistance:
N/A
 
Added to system:
12/13/18 10:56 AM

Job Code:
370.181213.5927/HPP
 
 

Quality Analyst I

If you’re interested in a career within a customer-focused, team-oriented environment that rewards innovation, quality, integrity and collaboration, MedImpact Healthcare Systems, Inc. welcomes your application. MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market.   MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

Position Summary

The Quality Analyst participates in the execution of an effective quality assurance program to ensure that the operational components of MedImpact's PBM program and services meet client requirements and government regulations. This position works under general supervision and a limited degree of independence, creativity and latitude is required.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

  • 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 MedImpact'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 MedImpact
  • 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 MedImpact
  • 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

Education and/or Experience           

Level I

For consideration, candidates will need a Bachelor's degree from four-year College or University along with one (1) to three (3) years testing experience and/or training; or equivalent combination of education and job related experience.  Managed Care, Government Programs or PBM Quality experience is preferred.

Computer Skills               

  • Intermediate to advanced skills in Microsoft Office with an emphasis on Word, Excel, MS Access and Project
  • Intermediate to advanced skills in SQL queries

Other Skills and Abilities                                                            

  • 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

This position is eligible for Employee Referral Bonus at Level I

EOE, M/F/D/V

OSHA/ADA:

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer:

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.