Pharmacy Audit Analyst - National 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 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.
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
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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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
