Pharmacy Audit Analyst

UnitedHealth Group•Irvine, CA

7d•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. Schedule: Monday through Friday with 8-hour shifts between the hours of 6am-5pm PST You will enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. Primary 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 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 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

Nice To Haves

In-depth knowledge of pharmacy operations
All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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

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.)

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