Remote Pharmacy Audit Analyst - Overpayments & Compliance

Taleo; Minnetonka (MN); Remote; USD 50,000 - 89,000; Full time

Benefits offered by this job

Paid Time Off

Medical Plan options

Dental and Vision

Job summary

UnitedHealth Group is seeking a Pharmacy Audit Analyst to identify and document fraudulent or erroneous audit findings, prepare and amend audit reports to determine overpayments, and collaborate on reverse billing of overpayments. The role requires pharmacy license, PTCB, and healthcare audit experience.

This position offers telecommuting within the U.S. with standard 8-hour shifts; salary ranges from $49,700 to $88,800 per year, with comprehensive benefits and ongoing career development

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 in pharmacy audit, PBM, healthcare investigations, or health insurance environment.
• 2+ years of experience processing/auditing pharmacy claims.
• Intermediate level of proficiency with Microsoft Excel.

Responsibilities

• Identify and document fraudulent or erroneous activities from audits.
• Prepare audit reports and determine overpayments.
• Amends audit reports and determines overpayments.
• Collaborate with Claims Administration on reverse and re-billing of overpaid claims.
• Coordinate timely closure of audits.
• Review and analyze claims data to determine details of overpayment billing activity.
• Monitor and report compliance with regulatory requirements.

Skills

Pharmacy technician

PTCB certification

Audit experience

Excel proficiency

Shift availability

Tools

Microsoft Excel

Job description

UnitedHealth Group is seeking a Pharmacy Audit Analyst to identify and document fraudulent or erroneous audit findings, prepare and amend audit reports to determine overpayments, and collaborate on reverse billing of overpayments. The role requires pharmacy license, PTCB, and healthcare audit experience.

This position offers telecommuting within the U.S. with standard 8-hour shifts; salary ranges from $49,700 to $88,800 per year, with comprehensive benefits and ongoing career development