Clinical QA Specialist

Job description

ESSENTIAL DUTIES AND RESPONSIBILITIES Included but not limited to the following:  Execute QA-related tasks and processes in the Business QA department.  Provide Specific attention to clinical changes for government programs.  Review and validate that rules and utilization management along with clinical edits are programmed against clinical policies accurately.  Write reports that will produce accurate information needed to validate that clinical changes are accurate.  Review all material at hand to determine if benefit changes match requests from the client.  Provide feedback to multiple departments on benefit configuration supporting clinical requests.  Work with various departments as needed to have plans updated to satisfy requested changes.  Perform pre and post implementation testing on benefit set up to ensure claims process accurately.  Document and track testing procedures for new functionality.  Make presentations to your peers as a department learning tool.  Miscellaneous duties as requested QUALIFICATIONS AND REQUIREMENTS:  Certified Pharmacy Technician with at least 3 years experience required.  Strong knowledge of pharmacy terminology and medication manage...