MedImpact Healthcare Systems, Inc. · 9 hours ago
Quality Analyst II
San Diego, CA
Full-time
Onsite
Mid Level
$29.32/hr - $48.38/hr
3+ years expMedImpact Healthcare Systems, Inc. is looking for extraordinary people to join their team! This role participates in the execution of an effective quality assurance program to ensure that the operational component of MedImpact’s PBM programs and services meet client requirements and government regulations.
Health CarePharmaceutical
No H1B
Responsibilities
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 Medlmpact'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 Medlmpact. 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 Medlmpact
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
Qualification
Required
BS/BA and 3+ years' experience or equivalent combination of education and experience
Previous experience writing SQL queries, Automation Testing, File Transfer Protocol and UNIX is highly desirable
Intermediate to advanced skills in Microsoft Office with an emphasis on Word, Excel, MS Access and Project
Intermediate to advanced skills in SQL queries
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
Demonstrated ability to work in a fast paced environment, learn quickly, appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form
Ability to deal with problems involving several concrete variables in standardized situations
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations
Ability to write reports, business correspondence, and procedure manuals
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations
Preferred
Healthcare, Managed Care, Government Programs or PBM Quality experience is preferred
Benefits
Medical / Dental / Vision / Wellness Programs
Paid Time Off / Company Paid Holidays
Incentive Compensation
401K with Company match
Life and Disability Insurance
Tuition Reimbursement
Employee Referral Bonus
Company
MedImpact Healthcare Systems, Inc.
MedImpact is the nation’s largest independent health solutions and pharmacy benefit company, serving commercial health plans, government programs, self insured/employer groups, and millions of consumers.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
$1.38M2013-09-19Seed· $1.38M
Leadership Team
Frank Bunton
VP, CISO (Chief Information Security Officer)
Larry Biggs
Manager, Information Security
Recent News
Pharmacy Benefit Management Institute®
2025-09-26
2025-09-12
Company data provided by crunchbase