Pharmacy Audit Analyst - National Remote

Optum; Irvine (CA); Remote; USD 49,000 - 97,000; Full time

Job summary

Join a forward-thinking organization dedicated to improving health outcomes through innovative technology. This role offers the flexibility to telecommute while you tackle complex challenges in pharmacy audits and compliance. You'll work with a diverse team, ensuring timely closure of audits and collaborating on claims administration. Enjoy a comprehensive benefits package, including paid time off and a 401(k) savings plan. Be part of a mission-driven company that values diversity and inclusion, where your contributions will make a significant impact on the communities we serve.

Benefits

Paid Time Off

Medical Plan Options

Dental and Vision Insurance

401(k) Savings Plan

Education Reimbursement

Employee Discounts

Employee Assistance Program

Referral Bonus Program

Voluntary Benefits

Qualifications

• Current Pharmacy Technician License required.
• 2+ years of experience in pharmacy audit or healthcare investigations.

Responsibilities

• Identify and document fraudulent activities through audits.
• Prepare audit reports and determine overpayments.
• Collaborate with Claims Administration on billing issues.

Skills

Pharmacy Technician License

Pharmacy Audit Experience

Healthcare Investigations

Data Analysis

Microsoft Excel

Education

High School Diploma

Pharmacy Technician Certification

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

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

Position Schedule: Monday through Friday with 8-hour shifts between the hours of 6am-5pm PST

Primary Responsibilities:

• Identify and document fraudulent or erroneous activities determined because 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

What are the reasons to consider working for UnitedHealth Group?Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays


• Medical Plan options along with participation in a Health Spending Account or a Health Saving account


• Dental, Vision, Life& AD&D Insurance along with 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.)


• More information can be downloaded at: http://uhg.hr/uhgbenefits

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


• 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/auditing pharmacy claim


• Intermediate level of proficiency with Microsoft Excel


• Ability to work an 8-hour shift, Mondays - Fridays, between the hours of 6 am-5 pm PST


• Must be 18 years of age or older

Preferred Qualifications:

• In-depth knowledge of pharmacy operations

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

The salary range for this role is $49,300 to $96,400 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

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

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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

#RPO #Green