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Controls and Quality Analyst

Company: Southern Scripts
Location: Dallas
Posted on: August 7, 2022

Job Description:

Controls and Quality Analyst (remote position)We wanted a PBM that worked better--- so we created one. Southern Scripts, the leading disruptor in the PBM industry, simplifies the complexities of navigating through the Pharmacy Benefit Manager world by offering a value-added approach to ensure the employer absolute freedom, control, and choice to their health plan structure without compromising patient experiences and outcomes. We improve healthcare and reduce rising prescription costs for employers and their employees. We are looking for individuals who are passionate, strong, and committed to developing systems and service solutions that promote our business goals and commitments.Southern Scripts is searching for incredible talent! We continue to experience accelerated growth in a rapidly changing industry. There's never been a better time to join our team. We are currently seeking a Controls and Quality Analyst. This is a fully remote/work from home position.Role and ResponsibilitiesThe Controls and Quality Analyst is responsible for developing, monitoring, assessing, reviewing, and recommending changes to Southern Scripts' quality and control procedures to ensure the highest quality standards in accordance with company policies. The Controls and Quality Analyst works closely with the Claims Processing Manager, Claims Processing team, and the Director of Operations. The Controls and Quality Analyst documents all findings and provides feedback to the Claims Processing Manager and Director of Operations as required. This role is heavily analytical and requires critical thinking skills.Responsible for developing additional quality assurance for internal processes. Understand and define the performance and quality standards expected of Claims Processing employees.Evaluate quality standards from an objective point of view and ensuring the proper checks and balances are applied to all parts of the Claims Processing procedures.Responsible for being fully trained in both RxClearinghouse and SoloRx so an adequate knowledge base can be used when evaluating and crafting procedures. Participate in the design of procedures of but not limited to reimbursement audits, group/plan design, SoloRx ticket updates, group/plan changes, SOC audits, and testing groups in SoloRx. Remain current on plan knowledge, policies, processes, procedures, and systems knowledge of Southern Scripts procedures. Provide continual evaluation, identify, and solve for inefficiencies of existing processes and procedures. Create a culture of continuous improvement. Potentially responsible for providing training internal teams on new procedures implementing updated quality controls.Assist with group/plan design, when necessary.Provide detailed reporting, when applicable.Abide by all obligations under HIPAA related to Protected Health Information (PHI).If a HIPAA violation is discovered, whether individually or by another, you must report the violation to the Compliance Officer and/or Human Resources.Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company.Flexibility to understand, appreciate and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice. What We Have to OfferOur benefits package is designed to keep our employees happy and healthy - physically, mentally and financially. Servant CultureMedical, Dental, Vision insuranceDisability and Life insuranceEmployee Assistance ProgramRemote work optionsGenerous Paid-Time OffAnnual Reviews and Development PlansRetirement Plan with company match immediately 100% vested Required Skills and CompetenciesProblem Solving/AnalysisCritical Thinking Time ManagementCommunicationObjectivity Technical Expertise Perform root cause analysis Strong written and verbal communication skillsExceptional listening and analytical skillsProficient in Word, Excel, and PowerPoint for presentations and reports required Position Type and Expected Hours of WorkThis is a full-time salaried position. Days and hours of work are Monday through Friday; 40+ hours a week, with occasional after-hours or weekend duties. TravelMinimal travel expected for this position to Natchitoches, Louisiana for training and development. Required Education and ExperienceBachelor's Degree2 years of PBM experience Preferred Education and Experience:Bachelor's degree preferredSupervisory background preferredSouthern Scripts, LLC and all entities provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Southern Scripts complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.Southern Scripts expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Southern Scripts employees to perform their job duties may result in discipline up to and including discharge. EOE M/F/V/D PI188016682

Keywords: Southern Scripts, Dallas , Controls and Quality Analyst, Professions , Dallas, Texas

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