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Pharmacy Audit Analyst

3 months ago

Eden Prairie, Minnesota, United States Optum Full time

Join a Global Organization: At Optum, we are dedicated to improving health outcomes on a global scale by connecting people with the care, pharmacy benefits, data, and resources they need. Our culture is built on diversity and inclusion, providing you with talented peers, comprehensive benefits, and career development opportunities.

Position Overview: As a member of our team, you will play a crucial role in advancing health equity while directly impacting the communities we serve. Join us in Caring. Connecting. Growing together.

Work Schedule:

  • When working remotely, you will have the option to work a compressed schedule with 10-hour days Monday – Thursday with Friday off
  • When field-based or travelling, shift will be 8 hours Monday – Friday between 8 am – 5 pm EST
  • Travel Requirement: This position involves travel within a specific demographic, up to 75% of the calendar year by car, plane, or train.

Primary Responsibilities:

  • Complete pre-audit work independently including travel planning and materials gathering
  • Conduct pharmacy network audits to identify potential discrepant pharmacy claims
  • Assess pharmacy sites for compliance with regulations and record completeness
  • Review documentation and facilitate answers to providers
  • Report audit findings and assess quality and accuracy

Requirements:

  • High School Diploma/GED (or higher)
  • Current Pharmacy Technician license
  • Certification by PTCB or ExCPT
  • 2+ years of experience in pharmacy audit, PBM, or healthcare investigations
  • Proficiency in Microsoft Office
  • Valid driver's license and ability to travel up to 75% of the year

Preferred Qualifications:

  • Bachelor's Degree
  • Knowledge of health insurance laws and regulations
  • Certified Quality Auditor (CQA)
  • Problem-solving skills

About Telecommuting: Telecommuters must adhere to UnitedHealth Group's Telecommuter Policy.

Salary Information: Salary ranges vary based on factors such as local labor markets and qualifications. Additional benefits include a comprehensive package, incentives, equity stock purchase, and more.

Application Deadline: Job posting will remain active to gather a sufficient candidate pool.

At UnitedHealth Group, we strive to improve health outcomes for all, addressing health disparities and environmental impact. Our commitment to diversity and inclusion drives our mission to make the health system work better for everyone.

We are an Equal Employment Opportunity employer, fostering a healthier atmosphere through diversity and inclusivity. UnitedHealth Group is a drug-free workplace, and candidates must pass a drug test before employment.