Client Services Business Quality Assurance Analyst II - Medicaid Fee For Service

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join their team as a Client Services Business Quality Assurance Analyst II – Medicaid FFS. This role serves as a subject matter expert in benefit configuration and quality assurance, leading validation efforts and ensuring compliance with client requirements and internal standards.

Responsibilities:

• 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

Requirements:

• 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
• Composure
• Decision Quality
• Organizational Agility
• Problem Solving
• Customer Focus
• Drive for Results
• Peer Relations
• Time Management
• Dealing with Ambiguity
• Learning on the Fly
• Political Savvy
• Healthcare, Managed Care, Government Programs or PBM Quality experience is preferred