Pharmacy Audit Analyst

UnitedHealth Group • Montville, NJ

260d • $49,300 - $96,400 • 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. Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration, and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work. 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 state of North Carolina, Virginia or New Jersey, you will enjoy the flexibility to telecommute as you take on some tough challenges.

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 working independently and researching/conducting investigations
• Currently resides in the state of North Carolina, Virginia or New Jersey
• Currently located within 45 miles of International Airport
• Ability to travel (car, train, plane) up to 75% of the year
• Access to reliable transportation and valid US driver's license
• Must be 18 years of age or older

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 or other pharmacy claims processing systems
• Certified Quality Auditor (CQA)
• Ability to problem solve including multiple priorities and research conflicting and/or inaccurate information
• Must be self-motivated and can successfully investigate complex issues

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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities