Client Services Business Quality Assurance Analyst II - Medicaid Fee For Service
MedImpact Healthcare Systems, Inc.
- # Client Services Business Quality Assurance Analyst II - Medicaid Fee For ServiceApplyremote type: Remotelocations: San Diego, CA: Remotetime type: Full timeposted on: Posted Yesterdayjob requisition id: JR102561### Exemption Status:United States of America (Non-Exempt)### $29.32 - $38.85 - $48.38“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”This position is not eligible for Sponsorship.MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!# **Job Description****Summary**The Client Services Business Quality Assurance Analyst II – Medicaid FFS serves as a subject matter expert in benefit configuration and quality assurance across MedImpact’s PBM programs. This role leads complex validation efforts, oversees quality and compliance review activities, and ensures that configuration, operational processes, and deliverables meet client requirements and internal quality standards. Operating with a high degree of independence, this position drives continuous improvement, mentors analysts, and partners cross-functionally to enhance accuracy, efficiency, and compliance across the organization.**Essential Duties and Responsibilities** include the following. Other duties may be assigned.* Lead the design, execution, and oversight of complex configuration validation activities for benefit, pharmacy network, and formulary administration in pre‐production environments.* Apply advanced Configuration Services best practices to develop comprehensive test plans, data sets, test scenarios, expected results, and acceptance criteria.* Validate configuration accuracy for maintenance of business, new client implementations, regulatory updates, and special projects.* Analyze claims adjudication results to identify discrepancies, anomalies, and unintended consequences; recommend and implement corrective actions to optimize configuration design.* Approve configuration design plans for complex or unique benefit requests and ensure accurate migration of validated changes from Test to Production environments.* Develop, refine, and execute quality assurance procedures to ensure operational compliance with PBM standards and client requirements.* Lead quality and compliance review projects, including test execution, documentation of results, and development of corrective action plans.* Participate in internal and external audits of PBM services, ensuring findings are addressed promptly and effectively.* Perform high‐volume data testing across multiple file types to validate accuracy, completeness, and regulatory compliance.* Serve as a senior liaison to internal operational teams and external clients to improve the quality and compliance of PBM program implementations and ongoing operations.* Respond to complex inquiries regarding quality review outcomes, compliance requirements, and configuration validation processes.* Communicate significant issues, risks, and improvement opportunities to leadership, ensuring visibility and timely resolution.* Champion continuous quality improvement initiatives by identifying process gaps, recommending enhancements, and supporting implementation of efficiency improvements.* Mentor and coach Testing & Validation Analysts and Quality Analysts, providing guidance on test design, analysis techniques, regulatory interpretation, and best practices.* Contribute to the evolution of departmental methodologies, tools, and documentation to strengthen organizational quality and validation capabilities.**Supervisory Responsibilities** No supervisory responsibilities **Client Responsibilities**This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.**Qualifications**To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.**Education and/or Experience**BS/BA and 3+ years’ experience or equivalent combination of education and experience**Computer Skills**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.**Certificates, Licenses, Registrations**None required**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* 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. Demonstrate ability to meet or exceed the competencies as listed.* Healthcare, Managed Care, Government Programs or PBM Quality experience is preferred**Reasoning Ability** * 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.**Mathematical Skills** * 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.**Language Skills*** 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.**Competencies** To perform the job successfully, an individual should demonstrate the following competencies:ComposureDecision QualityOrganizational AgilityProblem SolvingCustomer FocusDrive for ResultsPeer RelationsTime ManagementDealing with AmbiguityLearning on the FlyPolitical Savvy**Physical Demands**The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Ability to maintain clear near visual acuity at approximately 20 inches or less (i.e., “close vision”) to accurately read fine print, view computer screens, and handle small objects. Requires adequate color vision and depth perception to support safety and precision in detail-oriented tasks.**Work** **Environment**The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).**Work Location**This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management approval based on business requirements). Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders.**Working Hours**This is a full-time non-exempt position requiring one to be able to work overtime from time to time in order to get the job done. Therefore, one must have the ability to work nights, weekends or on holidays as required. This may be changed at any time to meet the needs of the business. The typical working hours for this position are Monday through Friday from 8:00am to 5:00pm.**Travel**This position requires no travel; however, attendance may be required at various local conferences and meetings.# **The Perks:*** 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 BonusTo explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to
- J-18808-Ljbffr MedImpact Healthcare Systems, Inc.
Vacancy posted 3 days ago
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