Pharmacy Audit Analyst, Data Analytics – 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:

• Analyze book of business to determine patterns/trends of fraud, waste, abuse and error
• Amends audit reports and determines overpayments specific to fraud, waste, abuse and errors
• Collaborates with Claims Administration and/or management in the reverse and re – billing of overpaid claims specific to fraud, waste and abuse trends
• Collaborate on proactive solutions with client, client services, and legal team related to fraud, waste and abuse matters
• Present ideas and best practices to management to address business and operational process improvements
• Coordinating audit referrals to various audit types
• 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 contracted program
• Monitors and reports accordingly any compliance issues with regulatory requirement
• Identifies and documents fraudulent or erroneous activities determined as a result of a desktop or an on – site audit
• Prioritizes and organizes own work to meet agreed upon deadlines

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 in the state of residence
• National Pharmacy Technician Certification
• 3+ years of experience as a Pharmacy Technician
• 1+ years of experience in Pharmacy Audit
• Intermediate level of proficiency with computer skills including Microsoft Outlook, Word, and Excel
• Must be 18 years of age or older

Preferred Qualifications: 

• 5+ years of experience as a Pharmacy Technician
• RxClaims or other pharmacy claims system experience
• Retail Pharmacy experience
• Long Term Care Pharmacy experience
• Specialty Pharmacy experience 

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

 

California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington or Washington, D.C. Residents Only: The hourly range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington or Washington, D.C. residents is $48,300 to $94,500 per year. 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.

 

 

#RPO #Green