Pharmacy Audit Analyst - Frequent Travel Required

UnitedHealth Group; Irvine (CA); Remote; USD 50,000 - 89,000; Full time

Benefits offered by this job

Comprehensive benefits

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group is seeking a Pharmacy Auditor to perform pre-audit planning, travel, and both onsite and desktop audits within the U.S. The role emphasizes regulatory compliance, claims review, and collaboration with pharmacy network providers.

Requirements include 2+ years in pharmacy audit, a valid Pharmacy Technician license, and PTCB certification. Travel up to 75% is required; telecommuting is possible within the U.S.

Qualifications

• 2+ years in pharmacy audit, PBM, or health insurance investigations.
• 2+ years processing pharmacy or medical claims independently.
• Familiar with regulatory requirements and audit processes.

Responsibilities

• Complete pre-audit work including travel planning and desk audit activities.
• Conduct onsite and desktop audits to identify discrepant pharmacy claims.
• Assess sites for regulatory compliance and record completeness.
• Gather and review documentation up to but not including prescription copies.
• Answer questions from pharmacy network providers and report findings.
• Review the quality and accuracy of audits performed (QC).

Skills

Pharmacy audit

PTCB certification

Pharmacy Technician License

Microsoft Word

Microsoft Excel

Education

Bachelor's Degree

Tools

RxClaim

Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

This position requires travel (via car, plane, and train) within a specific demographic. Travel requirement can be up to 75% of the calendar year.

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary 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)

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• 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

Preferred Qualifications:

• 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

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $49,700 to $88,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.