Pharmacy Audit Analyst (Audit Coordinator) – National Remote

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 will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities: 

• Coordinate the overall onsite audit schedule for all field and desk auditors
• Assign pharmacy network audits to onsite Auditors, Sr Analysts, and any other applicable persons that conduct OSE audits
• Maintain onsite audit program communication channels (e.g., toll-free number voicemail box, onsite email box, and digital mailbox) and route to corresponding auditor
• Maintain onsite audit data metrics for work leveling purposes (e.g., auditor tact time, initiations, etc.)
• Manage auditor training documentation – policies and procedures
• Leads special projects as assigned
• Conduct onsite audits and/or desk reviews as needed

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.

Required Qualifications:

• Current and unrestricted Pharmacy Technician License for the state of residence
• Current National PTCB (Pharmacy Technician Certification Board) certification
• 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
• 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; must be self-motivated and can successfully investigate complex issues
• Must be 18 years of age or older

Preferred Qualifications:

• 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
• Strong communications skills, both verbal and written

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

 

The salary range for this role is $49,300 to $96,400 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives. 

 

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.  

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 

 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

 

 

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

 

 

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