Remote Pharmacy Audit Analyst – Overpayments & Compliance

Careerwebsite; Minnetonka (MN); Hybrid; USD 50,000 - 89,000; Full time

Benefits offered by this job

Paid Time Off

Medical Plan options

Dental Insurance

Vision Insurance

Life & AD&D Insurance

401(k) Savings Plan

Education Reimbursement

Employee Discounts

Employee Assistance Program

Employee Referral Bonus

Voluntary Benefits

Job summary

UnitedHealth Group is seeking a Pharmacy Audit Technician in the U.S. to identify and document fraudulent or erroneous audit activities and determine overpayments. The role includes preparing audit reports and collaborating on reverse/billing with Claims Administration.

Typical 8-hour shift, Monday–Friday, 6 am–5 pm PST with telecommute options within the U.S. The salary ranges from $49,700 to $88,800 annually for full-time employment.

Qualifications

• Active and unrestricted Pharmacy Technician license in the state of residence.
• Active National Certification 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 claims.
• Intermediate level of proficiency with Microsoft Excel.
• Ability to work an 8-hour shift, Monday - Friday, between the hours of 6 am-5 pm PST.

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 any compliance issues with regulatory requirements.

Skills

Pharmacy audit experience

Excel proficiency

Claims auditing

Education

Active Pharmacy Technician license

PTCB certification

Tools

Microsoft Excel

Job description

UnitedHealth Group is seeking a Pharmacy Audit Technician in the U.S. to identify and document fraudulent or erroneous audit activities and determine overpayments. The role includes preparing audit reports and collaborating on reverse/billing with Claims Administration.

Typical 8-hour shift, Monday–Friday, 6 am–5 pm PST with telecommute options within the U.S. The salary ranges from $49,700 to $88,800 annually for full-time employment.