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Pharm Tech Audit Analyst - Irvine, CA
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Irvine, CA Irvine, California |
About this job
We're changing the way health care works for the better. That means consulting with our members, partnering with our physicians, and delivering drugs in the most efficient and effective way. Join us and start doing your life's best work.(sm)
Positions in this function analyze and monitor claims against fraud, waste and abuse related to retail pharmacy and long-term care networks. Investigates, reviews and analyzes claims data applying knowledge of pharmacy policy and practice and data mining techniques to determine details of fraudulent, erroneous, or abusive billing activity. May conduct on-site audits at pharmacies, physician offices and long-term care facilities. Site audits include assessment of physical premises, compliance with regulatory requirements, and completeness of provider/clinical records and itemized bills. Identifies and documents fraudulent or erroneous activities determined as a result of an audit. Prepares audit reports and determines overpayments. Formal documentation may be prepared for chief compliance officer and company attorneys. Notifies and works with government enforcement agencies as appropriate. Perform various duties related to providing support to the pharmacy outsourced audit program. Auditors typically are licensed pharmacy technicians with in-depth knowledge of pharmacy operations. Nationally certified technicians and technicians with investigative experience are preferred.
Primary Responsibilities:
�Answer inbound calls from pharmacies and Customer Service.
�Manages database tools for internal processing of various components of pharmacy audit reports received from outsourced vendor.
�Maintain daily interface and vendor relationship for provider network audit functions related to contractual accuracy and provider credentials.
�Coordinate the development of pharmacy audit result reports as needed.
�Contributes to team effort by consistently meeting established productivity, schedule adherence, and quality standards while maintaining a good attendance record.
Positions in this function analyze and monitor claims against fraud, waste and abuse related to retail pharmacy and long-term care networks. Investigates, reviews and analyzes claims data applying knowledge of pharmacy policy and practice and data mining techniques to determine details of fraudulent, erroneous, or abusive billing activity. May conduct on-site audits at pharmacies, physician offices and long-term care facilities. Site audits include assessment of physical premises, compliance with regulatory requirements, and completeness of provider/clinical records and itemized bills. Identifies and documents fraudulent or erroneous activities determined as a result of an audit. Prepares audit reports and determines overpayments. Formal documentation may be prepared for chief compliance officer and company attorneys. Notifies and works with government enforcement agencies as appropriate. Perform various duties related to providing support to the pharmacy outsourced audit program. Auditors typically are licensed pharmacy technicians with in-depth knowledge of pharmacy operations. Nationally certified technicians and technicians with investigative experience are preferred.
Primary Responsibilities:
�Answer inbound calls from pharmacies and Customer Service.
�Manages database tools for internal processing of various components of pharmacy audit reports received from outsourced vendor.
�Maintain daily interface and vendor relationship for provider network audit functions related to contractual accuracy and provider credentials.
�Coordinate the development of pharmacy audit result reports as needed.
�Contributes to team effort by consistently meeting established productivity, schedule adherence, and quality standards while maintaining a good attendance record.
Requirements
- Undergraduate degree or equivalent experience.
Strong computer skills, specifically with Microsoft Office (Word, Excel , etc...)
Strong communications skills
Strong organizational skills, must be detailed
Pharmacy Technician License and National certification required
4 Years Pharmacy or PBM experience required
1 year Investigative experience required
UnitedHealth Group is working to create the health care system of tomorrow.
Already Fortune 25, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.
Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.
Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.
Strong computer skills, specifically with Microsoft Office (Word, Excel , etc...)
Strong communications skills
Strong organizational skills, must be detailed
Pharmacy Technician License and National certification required
4 Years Pharmacy or PBM experience required
1 year Investigative experience required
UnitedHealth Group is working to create the health care system of tomorrow.
Already Fortune 25, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.
Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.
Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
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