Pharmacy Audit Analyst

UnitedHealth Group • Eden Prairie, MN

12h • Remote

About The Position

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
This position requires travel (via car, plane, and train) within a specific demographic. Travel requirement can be up to 75%25 of the calendar year.
You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
This role requires nationwide travel by car, train and/or plane up to 75%25 of the year
Complete pre-audit work including travel planning, materials gathering and desk audit activities independently and in accordance with established objectives
Perform onsite and desktop pharmacy network audits to identify potential discrepant pharmacy claims
Assess pharmacy site’s physical premises, compliance with regulatory requirements, 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 on pharmacy network providers
Reviews and assesses quality and accuracy of audits conducted (QC)
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
Medical Plan options along with participation in a Health Spending Account or a Health Saving account
Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
401(k) Savings Plan, Employee Stock Purchase Plan
Education Reimbursement
Employee Discounts
Employee Assistance Program
Employee Referral Bonus Program
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Requirements

• Active and unrestricted Pharmacy Technician license in the state of residence
• Active and unrestricted 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 pharmacy or medical claims
• 1+ years of experience leading in-person and virtual/desktop audits
• Intermediate level of proficiency with pharmacy operations
• Intermediate level of proficiency with Microsoft Office (Word - creating and editing documents, Excel – creating, filtering, and maintaining spreadsheets)
• Intermediate level of proficiency in working independently and researching/conducting investigations
• Currently located within 45 miles of International Airport
• Ability to travel nationwide (car, train, plane) up to 75%25 of the year
• Access to reliable transportation & valid US driver's license
• Must be 18 years of age OR older

Nice To Haves

• Intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to health insurance (Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy and/or commercial health insurance)
• Proficient in RxClaim or other pharmacy claims processing systems
• Certified Quality Auditor (CQA)
• Ability to solve problems including multiple priorities and research conflicting and/or inaccurate information

Responsibilities

• This role requires nationwide travel by car, train and/or plane up to 75%25 of the year
• Complete pre-audit work including travel planning, materials gathering and desk audit activities independently and in accordance with established objectives
• Perform onsite and desktop pharmacy network audits to identify potential discrepant pharmacy claims
• Assess pharmacy site’s physical premises, compliance with regulatory requirements, 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 on pharmacy network providers
• Reviews and assesses quality and accuracy of audits conducted (QC)

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed