QA Analyst PBM Implementation - Remote

Job Posting Title

QA Analyst PBM Implementation - Remote

Job Description

The Quality Assurance (QA) Analyst performs complex quality reviews and serves as a subject matter expert and primary information resource for any escalated QA issues and questions. This role provides project support and feedback on implementations and reporting for QA-related activities.

Responsibilities

• Perform research and assist leadership in identification of potential missed turnaround times on review related to applicable quality tests
• Perform ongoing inter-rater reliability exercises and quality reviews for less tenured staff and provide performance feedback and information to identify areas of improvement
• Perform complex quality reviews and analysis of cases to prevent errors based on strict compliance, service level agreements, and regulatory guidance
• Discover outliers and areas of improvement on work product of reviewers; provide feedback for improvement to prevent quality issues
• Assist in the gathering, documenting, and implementations of requirements for new and future system enhancements
• Serve as liaison for directing unresolved issues for further evaluation and resolution
• Collaborate with trainers and writers to provide feedback for training modules and documentation
• Other duties as assigned

Minimum Qualifications

• Bachelor's degree in Business, Liberal Arts, or related area of study, or equivalent combination of education and/or related work experience; HS diploma or GED is required
• 2 years of experience within Claims Processing, Audit, Quality or Pharmacy
• Must be eligible to work in the United States without need for work visa or residency sponsorship
• If position sits within Clinical Review Department, the following qualifications are also required:
• 1 year of experience as a Clinical Review Technician or 2 years of experience in Clinical Review
• If position sits within Pharmacy Audit department, the following qualifications are also required:
• National Pharmacy Technician Certification through PTCB or ExCPT (CPhT)
• 2 years of experience working directly in a pharmacy

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• Strong organizational, analytical, interpretive, and time management skills
• Ability to make consistent and unbiased decisions
• Strong interpersonal, verbal and written communication skills
• Ability to provide work direction to others
• Ability to work under strict timelines while managing multiple priorities simultaneously
• Ability to analyze data using analytical tools (e.g. Microsoft Excel)

Preferred Qualifications

• National Pharmacy Technician Certification through PTCB or ExCPT (CPhT) or Licensed Practical Nurse certification if working in Medicare
• Healthcare, audit, and/or reporting and metrics environment experience
• Experience using RxClaim
• Experience in benefit design and review process for multiple clients
• PBM or healthcare experience

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

Potential pay for this position ranges from $59,000.00 - $94,000.00 based on experience and skills.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco-Free Workplace employer. Positions will be posted for a minimum of five consecutive workdays.