Pharmacy Audit Analyst, Remote in MI or OH or IL or IN, Travel up to 75%
Location: Detroit, Michigan
Internal Number: 117798770
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.(sm)
If you are located in Michigan, you will have the flexibility to telecommute* as you take on some tough challenges.
This position requires travel (via car, plane, and train) within a specific demographic. Travel requirement can be up to 75% of the calendar 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)
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.
High school diploma or GED
Current and unrestricted Pharmacy Technician License for the state of residence
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
Experience with Microsoft Office (Word - creating and editing documents, Excel – creating, filtering, and maintaining spreadsheets)
Experience working independently and researching/conducting investigations; must be analytical, self-motivated, goal oriented, and have the ability to successfully investigate complex issues
Experience leading in person and virtual/desktop audits
In - depth knowledge of pharmacy operations
Home Location within a commutable distance to an International Airport
Ability to travel (car, train, plane) up to 75% of the year
Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state, and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
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
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you’ll fill far more than prescriptions. As a member of one of our pharmacy teams, you’re empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.