The Pharmacy Government Programs-Quality Assurance Coordinator is responsible for the monitoring and quality check implementation and the coordination of a robust and effective quality assurance verification process for our Medicare and other Government Programs as defined by CMS, DOH, Assist Director, Pharmacy, and/or the Government Compliance Officer. Conduct routine and demonstrated monitoring of the Pharmacy department’s processes related to meeting the Medicare Part D and other government regulatory Requirements and the company’s Government specific Compliance Plans to ensure that the effectiveness of services provided can be readily assessed in terms of quality and completeness. The Pharmacy Monitoring-Quality Assurance Assistant is accountable for collaborating with management on quality assurance reviews, monitoring procedures, defining relative trend analysis, and process improvements. They will perform, communicate and continually refine all aspects of effectively monitoring processes related to Medicare Part D and Medicaid Claims processing, Formularies, Exceptions, Fraud Waste and Abuse, Communication, Marketing materials, Pharmacy Help Desk, and other related Pharmacy processes. They are responsible for documenting quality assurance efforts, reporting results, trending, and escalating any pertinent issues to area managers and the Assistant Director when needed. Holidays, weekends and overtime may be required and is a condition of employment.
Associates degree from an accredited institute required, Bachelor’s degree preferred
Two (2) years’ experience in pharmacy or health care service field
Two (2) years’ work experience with Medicare. Medicaid or other Government Program strongly preferred
Minimum of one (1) year experience with relevant Quality Assurance and or compliance monitoring.
Demonstrated ability to research and interpret policies and SOPs to ensure monitoring of processes are appropriate timely and accurate experience in interpret ting defined Policy, processes, or other documents and then identifying quality check and monitoring needs as it applies to Monitoring the program
Demonstrated and comprehensive understanding of QA methodologies and ability to adapt them to the specific needs of the program, department or organization
Claims data entry experience preferred.
Strong Microsoft Office skills, Proficient in Excel, Word, and Access
Excellent written and verbal communication skills required.
Maintains confidentiality and uses only the minimum amount of protected health information (PHI) necessary to accomplish job related responsibilities.
Other duties as needed. Every associate is given a job description upon hire outlining the qualifications, duties, and pay grade of the position. Independent Health reserves the right to change job descriptions as necessary.
Independent Health is an equal opportunity employer.
Independent Health - 21 months ago