Remote Pharmacy Audit Analyst | 75% Travel

Colorado Psychiatric; Irvine, Northern (CA, KY); Hybrid; USD 50,000 - 89,000; Full time

Job summary

UnitedHealth Group is seeking a Pharmacy Audit Specialist to conduct pre-audit planning, onsite and desktop audits, and assess regulatory compliance of pharmacy sites. You will gather documentation, answer provider questions, and report findings to pharmacy networks.

Ideal candidates hold a PTCB certification, a state license, and 2+ years in pharmacy audit or claims processing, with strong MS Office skills and the ability to travel up to 75% and work remotely.

Qualifications

• Current and unrestricted Pharmacy Technician License for the state of residence.
• Must be currently certified by the PTCB.
• 2+ years of experience in pharmacy audit or health insurance environments.
• 2+ years processing pharmacy or medical claims.
• 2+ years investigating independently with analytical mindset.
• Proficient in Microsoft Office (Word, Excel).
• Home location within 45 miles of International Airport.
• Ability to work remotely and travel up to 75%.

Responsibilities

• Complete pre-audit work including travel planning and desk audit activities.
• Perform onsite and desktop pharmacy network audits to identify discrepant claims.
• Assess pharmacy site compliance and records completeness.
• Gather and review documentation related to audits.
• Facilitate answers to questions from network providers.
• Report audit findings to providers.
• Review quality and accuracy of audits conducted.

Skills

Pharmacy audit

PTCB certification

Pharmacy license

Claims processing

Independent investigations

MS Office

Travel readiness

Education

Bachelor's Degree

Tools

RxClaim

Pharmacy claims systems

Job description

UnitedHealth Group is seeking a Pharmacy Audit Specialist to conduct pre-audit planning, onsite and desktop audits, and assess regulatory compliance of pharmacy sites. You will gather documentation, answer provider questions, and report findings to pharmacy networks.

Ideal candidates hold a PTCB certification, a state license, and 2+ years in pharmacy audit or claims processing, with strong MS Office skills and the ability to travel up to 75% and work remotely.