Pharmacy Audit Analyst - Travel Required
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.
Requirements
- Current and unrestricted Pharmacy Technician License for the state of residence
- Must be currently certified by the PTCB (Pharmacy Technician Certification Board)
- Home Location within 45 miles of International Airport
- 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
- Experience with Microsoft Office (Word - creating and editing documents, Excel – creating, filtering, and maintaining spreadsheets)
- Experience working independently and researching/conducting investigations; must be analytical, self-motivated, goal oriented, and have the ability to successfully investigate complex issues
- Experience leading in-person and virtual/desktop audits
- In - depth knowledge of pharmacy operations
- Work remotely AND travel (car, train, plane) up to 75%25 of the year
Nice To Haves
- Bachelor’s Degree
- 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)
- Proven ability to problem solve including multiple priorities and research conflicting and/or inaccurate information
Responsibilities
- 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 to pharmacy network providers
- Reviews and assesses quality and accuracy of audits conducted (QC)
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
