Pharmacy Audit Analyst - National Remote

Summary

UnitedHealth Group’s Optum organization delivers technology-enabled care, pharmacy benefits, data, and resources to improve health outcomes. The Pharmacy Audit Analyst identifies fraudulent or erroneous pharmacy claim activity, prepares audit reports, determines overpayments, coordinates audit closures, and monitors regulatory compliance.

Responsibilities

• Identify and document fraudulent or erroneous activities determined as a result of an audit
• Prepare audit reports and determine overpayments
• Amends audit reports and determines overpayments
• Collaborates with Claims Administration in the reverse and re - billing of overpaid claims
• Coordination of timely closure of audits
• Reviews and analyzes claims data, applying knowledge of pharmacy policy / practice and data mining techniques to determine details of overpayment billing activity while assisting with oversight of various audit programs
• Monitors and reports accordingly any compliance issues with regulatory requirement

Skills

• Active and unrestricted Pharmacy Technician license in the state of residence
• Active National Certification 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/auditing pharmacy claim
• Intermediate level of proficiency with Microsoft Excel
• Ability to work an 8-hour shift, Monday - Friday, between the hours of 6 am-5 pm PST
• Ability to train Monday - Friday from 8 AM - 5 PM PST
• Must be 18 years of age OR older
• In-depth knowledge of pharmacy operations

Qualifications

Must Haves

• Active and unrestricted Pharmacy Technician license in the state of residence
• Active National Certification 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/auditing pharmacy claim
• Intermediate level of proficiency with Microsoft Excel
• Ability to work an 8-hour shift, Monday - Friday, between the hours of 6 am-5 pm PST
• Ability to train Monday - Friday from 8 AM - 5 PM PST
• Must be 18 years of age OR older

Nice to Haves

• In-depth knowledge of pharmacy operations

Benefits

• Flexibility to telecommute from anywhere within the U.S.
• Paid Time Off which you start to accrue with your first pay period
• 8 Paid Holidays
• Medical Plan options
• Participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life & AD&D Insurance
• Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan
• Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• Performance rewards
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution