Job Title: Sr. QA/Tester-PBM Healthcare Regulatory & Pharmacy Standards (CMS / NCPDP Compliance)
Location: Remote
Employment Type: Full-time with Infinite Computer Solutions
Position Overview
We are seeking an experienced Quality Assurance (QA) Analyst with strong knowledge of U.S. healthcare regulatory standards, pharmacy compliance requirements, and electronic prescribing (eRx) workflows. The ideal candidate will have handson QA experience combined with a solid understanding of CMS rulings and NCPDP standards, particularly those governing pharmacy transactions, subrogation, and ePrescribing.
This role focuses on validating system functionality, data accuracy, and compliance with federal mandates, ensuring that all pharmacyrelated interfaces and data exchanges meet regulatory expectations.
Key Responsibilities
Perform comprehensive QA testing for pharmacy, ePrescribing, and Medicaidrelated applications.
Validate system compliance with key U.S. Department of Health and Human Services (HHS) rulings, including:
CMS0056F: Retail Pharmacy Standard and Medicaid Pharmacy Subrogation Standard
CMS4205F: ePrescribing (eRx) compliance with NCPDP SCRIPT and NCPDP Formulary & Benefit Standards
Develop detailed test plans, test cases, and test scripts aligned with regulatory requirements.
Conduct functional, integration, regression, and endtoend testing for pharmacy and eRx workflows.
Validate data mapping, data transformations, and file formats used in pharmacy transactions.
Collaborate with business analysts, developers, and compliance teams to interpret regulatory requirements and ensure accurate implementation.
Analyze defects, document findings, and work with technical teams to drive timely resolution.
Participate in requirement reviews, design discussions, and sprint ceremonies.
Support audit activities, compliance documentation, and regulatory reporting as needed.
Stay current on CMS, NCPDP, and HHS regulatory updates impacting pharmacy and ePrescribing systems.
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