Pharmacy Audit Analyst - Frequent Travel Required

Summary

UnitedHealth Group's Optum organization delivers care aided by technology to help people live healthier lives. The Pharmacy Audit Analyst conducts pharmacy network audits, investigates discrepant claims, assesses compliance and records, communicates findings, and performs audit quality control while traveling up to 75% of the year.

Responsibilities

• Complete pre-audit work including travel planning, materials gathering and desk audit activities independently and in accordance with established objectives
• Performonsiteand desktop pharmacy network audits to identify potential discrepant pharmacy claims
• Assess pharmacy site's physical premises, compliance with regulatory requirements, and completeness of records
• Gather and review documentation up to but not including prescription hardcopies, signature logs, compounding records, and MARs
• Facilitate answers to questions from pharmacy network providers on a rotational basis
• Report findings to pharmacy network providers
• Reviews and assesses quality and accuracy of audits conducted (QC)

Skills

• Current and unrestricted Pharmacy Technician License for the state of residence
• Must be currently certified by the PTCB (Pharmacy Technician Certification Board)
• 2+ years of experience working in pharmacy audit, PBM, healthcare investigations, or health insurance environment
• 2+ years of experience in a position processing pharmacy or medical claims
• 2+ years of experience working independently and researching/conducting investigations; must be analytical, self-motivated, goal oriented, and could successfully investigate complex issues
• Advanced level of proficiency with Microsoft Office (Word - creating and editing documents, Excel - creating, filtering, and maintaining spreadsheets)
• Home Location within 45 miles of International Airport
• Ability to work remotely AND travel (car, train, plane) up to 75% of the year
• Experience leading in-person and virtual/desktop audits
• In - depth knowledge of pharmacy operations
• Bachelor's Degree
• Intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to health insurance (Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy and/or commercial health insurance)
• Proficient in RxClaim or other pharmacy claims processing systems
• Certified Quality Auditor (CQA)
• Proven ability to problem solve including multiple priorities and research conflicting and/or inaccurate information

Qualifications

Must Haves

• Current and unrestricted Pharmacy Technician License for the state of residence
• Must be currently certified by the PTCB (Pharmacy Technician Certification Board)
• 2+ years of experience working in pharmacy audit, PBM, healthcare investigations, or health insurance environment
• 2+ years of experience in a position processing pharmacy or medical claims
• 2+ years of experience working independently and researching/conducting investigations; must be analytical, self-motivated, goal oriented, and could successfully investigate complex issues
• Advanced level of proficiency with Microsoft Office (Word - creating and editing documents, Excel - creating, filtering, and maintaining spreadsheets)
• Home Location within 45 miles of International Airport
• Ability to work remotely AND travel (car, train, plane) up to 75% of the year

Nice to Haves

• Experience leading in-person and virtual/desktop audits
• In - depth knowledge of pharmacy operations
• Bachelor's Degree
• Intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to health insurance (Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy and/or commercial health insurance)
• Proficient in RxClaim or other pharmacy claims processing systems
• Certified Quality Auditor (CQA)
• Proven ability to problem solve including multiple priorities and research conflicting and/or inaccurate information

Benefits

• Flexible telecommuting from anywhere within the U.S.
• A comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Career development opportunities