Remote Pharmacy Audit Analyst - Audit & Compliance

Texas Health Institute; Minnetonka (MN); Hybrid; USD 50,000 - 89,000; Full time

Benefits offered by this job

Paid Time Off

Medical Plan options

401(k) Savings Plan

Job summary

UnitedHealth Group, operator of Optum, is seeking an experienced Pharmacy Audit Technician to identify fraudulent or erroneous activities and oversee overpayment adjustments. You will analyze claims data and document findings while collaborating with Claims Administration on reverse billing of overpayments.

Shifts are Mon-Fri 6am-5pm PST with potential telecommuting across the U.S. This role offers competitive benefits, including Paid Time Off, health plans, 401(k) and education reimbursement,

Qualifications

• Active and unrestricted Pharmacy Technician license in the state of residence.
• Active National Certification by the PTCB.
• 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.

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

Pharmacy technician license

PTCB certification

Excel

Tools

Excel

Job description

UnitedHealth Group, operator of Optum, is seeking an experienced Pharmacy Audit Technician to identify fraudulent or erroneous activities and oversee overpayment adjustments. You will analyze claims data and document findings while collaborating with Claims Administration on reverse billing of overpayments.

Shifts are Mon-Fri 6am-5pm PST with potential telecommuting across the U.S. This role offers competitive benefits, including Paid Time Off, health plans, 401(k) and education reimbursement,