Pharmacy Audit Analyst
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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. 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
- Current and unrestricted Pharmacy Technician license for the state of residence
- Currently certified by the PTCB (Pharmacy Technician Certification Board)
- 3+ years of experience in a position processing/auditing pharmacy claim
- 2+ years of experience working in pharmacy audit, PBM, healthcare investigations or health insurance environment
- 1+ years of pharmacy benefits management audit experience
- Intermediate level of proficiency with Microsoft Office products including Word (creating and editing documents) and Excel (creating and maintaining spreadsheets)
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 and online reporting
Responsibilities
- Uses pertinent data and facts to identify and solve a range of problems within area of expertise
- Investigates non-standard requests and problems, with some assistance from others
- Works exclusively within a specific knowledge area (audit)
- Prioritizes and organizes own work to meet deadlines
- Provides explanations and information to others on topics within area of expertise
- Assist with training Pharmacy Analysts and training new hires. (Side-by-side training & shadowing)
- Provides ideas and recommendations on process improvements, team building, etc.
- Develops and maintains team Job Aids for areas of expertise
- Communicates with pharmacies for their own audits except for escalations
- Updating non-chain correspondence preferences
Benefits
- In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
- No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
