On Site Pharmacy Auditor - Remote

Job Title

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.

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 are located in Washington, Oregon, or California, you will have the flexibility to work remotely
* as you take on some tough challenges. Will be onsite - traveling up to 75% of the time.

Primary 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 hard copies, 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.

Required Qualifications:

• 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 leading in person and virtual/desktop audits
• 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
• In - depth knowledge of pharmacy operations
• Ability to travel (car, train, plane) up to 75% of the year
• Home Location within a commutable distance to an International Airport
• 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. United Health 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

Preferred Qualifications:

• Bachelor's Degree
• 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

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest…