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Pharmacy Audit Representative - Irvine, CA
| Hours | Full-time, Part-time |
|---|---|
| Location | Irvine, CA Irvine, California |
About this job
Energize
your career with one of Healthcare's fastest growing companies.
You
dream of a great career with a great company – where you can make an impact and
help people. We dream of giving you the
opportunity to do just this. And with
the incredible growth of our business, it's a dream that definitely can come
true. Already one of the world's leading Healthcare companies, UnitedHealth
Group is restlessly pursuing new ways to operate our service centers, improve
our service levels and help people lead healthier lives. We live for the opportunity to make a
difference and right now, we are living it up.
This
opportunity is with one of our most exciting business areas: Optum –a growing
part of our family of companies that make UnitedHealth Group a Fortune 17 leader.
Optum helps nearly 60
million Americans live their lives to the fullest by educating them about their
symptoms, conditions and treatments; helping them to navigate the system,
finance their healthcare needs and stay on track with their health goals. No
other business touches so many lives in such a positive way. And we do it all
with every action focused on our shared values of Integrity, Compassion,
Relationships, Innovation & Performance.
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.
Primary Responsibilities:
- 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 onsite 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. Auditors
typically are licensed pharmacy technicians with in-depth knowledge of
pharmacy operations. Nationally certified technicians and technicians
with investigative experience are preferred.
Requirements
- High School Diploma or GED
- 2+ years of Pharmacy Technician experience
- Basic proficiency with MS Word and Excel
- California Pharmacy Technician License
- Working Hours 7:30 am to 4:00 pm Monday through Friday
Assets:
- National Pharmacy Technician Certification (CPhT)
- Compound Pharmacy experience
- Investigative/audit experience
OptumRx is
an empowering place for people with the flexibility to help create change.
Innovation is part of the job description. And passion for improving the lives
of our customers is a motivating factor in everything we do.
If you're ready to talk about groundbreaking
interactions, let's talk about what happens when a firm that touches millions
of lives decides to gather results from millions of prescriptions every month
and analyze their impact. Let's talk about smart, motivated teams. Let's talk
about more effective and affordable healthcare solutions. This is caring. This
is great chemistry. This is the way to make a difference. We're doing all this,
and more, through a greater dedication to our shared values of integrity,
compassion, relationships, innovation and performance. Join us and start doing your life's best work.
Diversity creates a healthier atmosphere: 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.
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