Remote Pharmacy Audit & Compliance Analyst

Sarasota Memorial Hospital; Minnetonka (MN); Hybrid; USD 50,000 - 89,000; Full time

Benefits offered by this job

Paid Time Off

Medical Plan

Dental Insurance

Vision Insurance

Life & AD&D Insurance

Short-term Disability

Long-Term Disability

401(k) Savings Plan

Employee Stock Purchase Plan

Education Reimbursement

Employee Discounts

Employee Assistance Program

Employee Referral Bonus Program

Job summary

UnitedHealth Group is seeking a Pharmacy Audit professional to identify and document fraudulent or erroneous activities uncovered by audits while preparing reports and determining overpayments. The role supports collaboration with Claims Administration to reverse and re-bill overpaid claims and ensure timely closure of audits.

You will analyze claims data, apply pharmacy policy and data-mining techniques, and monitor compliance with regulatory requirements.

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 claim.
• 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
• Ability to train Monday - Friday from 8 AM - 5 PM PST
• Must be 18 years of age OR older

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

PTCB Certification

Pharmacy audit experience

Excel proficiency

Tools

Microsoft Excel

Job description

UnitedHealth Group is seeking a Pharmacy Audit professional to identify and document fraudulent or erroneous activities uncovered by audits while preparing reports and determining overpayments. The role supports collaboration with Claims Administration to reverse and re-bill overpaid claims and ensure timely closure of audits.

You will analyze claims data, apply pharmacy policy and data-mining techniques, and monitor compliance with regulatory requirements.