Remote Pharmacy Audit Analyst — Frequent Travel

Taleo; Irvine (CA); On-site; USD 50,000 - 89,000; Full time

Benefits offered by this job

Benefits package

Incentive program

Equity stock plan

401k

Telecommuting policy

Job summary

UnitedHealth Group is seeking a Pharmacy Audit Analyst for frequent travel, with telecommuting within the United States. The role requires diligent audits of pharmacy networks, regulatory compliance checks and documentation review to identify discrepant claims.

Ideal candidates have a Pharmacy Technician License, PTCB certification, 2+ years in pharmacy audit/healthcare investigations, and strong MS Office skills. Travel up to 75% is expected.

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, Excel).
• Home Location within 45 miles of International Airport.

Responsibilities

• Complete pre-audit work including travel planning, materials gathering and desk audit activities independently and in accordance with established objectives
• Onsite and desktop pharmacy network audits to identify potential discrepant pharmacy claims
• Assess pharmacy site’s premises, regulatory compliance, 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)

Skills

PTCB Certification

Pharmacy audit experience

Independent research

MS Office proficiency

Education

Bachelor's Degree

Tools

RxClaim or similar

Job description

UnitedHealth Group is seeking a Pharmacy Audit Analyst for frequent travel, with telecommuting within the United States. The role requires diligent audits of pharmacy networks, regulatory compliance checks and documentation review to identify discrepant claims.

Ideal candidates have a Pharmacy Technician License, PTCB certification, 2+ years in pharmacy audit/healthcare investigations, and strong MS Office skills. Travel up to 75% is expected.