Job Description:

FIND YOUR FUTURE

We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and commitment to diversity and inclusion.

Overview

The QA/QC Coordinator is responsible for establishing and maintaining measurable monitoring and quality assurance tests of new and existing benefit designs, formulary changes, and system upgrades. The QA/QC Coordinator will perform auditing and will review test results to ensure correct functionality and identifies inaccuracies within the pharmacy online claims adjudication system. He/she will work with subject matter experts as part of a team to develop and implement corrective action plans to resolve system issues identified during the audit process. Occasional evenings, weekends and holidays are a requirement of the position.

Qualifications

• High School diploma or GED required; Associate's degree preferred.




• Three (3) years of experience in Quality Assurance/Quality Control, pharmaceutical or managed care environment required.




• Experience with pharmacy on-line claims processing systems preferred.




• Strong analytical, problem solving, time management and organizational skills.




• Detail-oriented, while maintaining an awareness of overall goals.




• Advanced PC and Windows skills. Experience with Microsoft Office applications, AS400 query and/or other query tools; and demonstrated ability to learn new software applications.




• Experience in report production, and the ability to maximize use of system capabilities to lead the organization in outcome improvement.




• Excellent interpersonal, written and verbal communication skills.




• Proven examples of displaying PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring.

Key Accountabilities

Quality Assurance and Auditing
Perform quality assurance and auditing processes to ensure accurate benefit information and functionality for adjudication within the pharmacy system; including but not limited to:

• Development, implementation and maintenance of manual and automated test scripts utilizing testing tools;




• Development, implementation and maintenance of test cases, data, files and strategies for benefit and formulary administration and system functionality;




• Participate in all aspects of testing including functional, regression, performance and system testing;




• Log and manage defect status and resolution grid;




• Development, implementation and maintenance of policies, procedures, manuals, and other necessary documentation of the QA/QC process;




• Audit application upgrade testing as necessary;




• Conduct internal audits to measure and ensure adherence to claims processing standards;




• Support cross-functional projects, represent pharmacy systems at team meetings, review requirements, develop test approach, and provide feedback; and




• Work on issues of moderate to complex scope where analysis of data is required.

Quality Control

This includes but is not limited to:

• Development of effective relationships that support appropriate feedback and development;




• Report quality assurance and audit results to management and leadership teams;




• Identify, monitor and communicate trends in inaccuracies and work with PBD system teams to resolve them;




• Perform ad hoc queries in audit database in support of decision making; and




• Perform integration testing, and track, document and verify and work with subject matter experts to resolve defects.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via their Career Worklet.