Pharmacy Audit Analyst

UnitedHealth Group Inc.•New York, NY

47d•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. This position requires travel (via car, plane, and train) within a specific demographic. Travel requirement can be up to 75% of the calendar year. If you reside in the states of New York, New Jersey, Connecticut, Massachusetts, New Hampshire or Rhode Island, you will enjoy the flexibility to telecommute 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 direction 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 in the state of residence
Must be currently certified 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 resides in New York, New Jersey, Connecticut, Massachusetts, New Hampshire or Rhode Island
Currently located within 45 miles of International Airport
Ability to travel nationwide (car, train, plane) up to 75% of the year
Access to reliable transportation & valid US driver's license
Must be 18 years of age or older

Nice To Haves

Certified Quality Auditor (CQA)
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
Ability to problem solve including multiple priorities and research conflicting and/or inaccurate information
Must be self-motivated and can successfully investigate complex issue
All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Responsibilities

This role requires nationwide travel by car, train and/or plane up to 75% 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 to pharmacy network providers
Reviews and assesses quality and accuracy of audits conducted (QC)