For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) Located in our Irvine, California office, the Pharmacy Audit Analyst will analyze and monitor claims against fraud, waste, and abuse related to retail pharmacy and long - term care networks. Primary Responsibilities:Amends audit reports and determines overpaymentsCollaborates with Claims Administration in the reverse and re - billing of overpaid claimsAnalyze and monitor claims data received from contracted entity related to retail pharmacy and long - term care networksCoordination of timely closure of auditsReviews and analyzes claims data, applying knowledge of pharmacy policy / practice and data mining techniques to determine details of overpayment billing activity while assisting with oversight of contracted programMonitors and reports accordingly any compliance issues with regulatory requirementIdentifies and documents fraudulent or erroneous activities determined as a result of an on - site auditAssists in the PARC appeal process
Required Qualifications:High School Diploma or equivalent 3+ years of experience as a Pharmacy Technician Current and unrestricted Pharmacy Technician license in the state of California3+ years of Pharmacy Audit experience Strong written communication skills Proficient computer skills including Microsoft Outlook, Word, and ExcelPreferred Qualifications:Bachelor's Degree preferred National Pharmacy Technician Certification RxClaims or other pharmacy claims system experience Retail Pharmacy experience Long Term Care Pharmacy experience Specialty Pharmacy experience 5 or more years of experience as a Pharmacy Technician Intermediate level Excel and Access skills a plusCareers 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) 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 Job Keywords: Pharm Tech, Pharmacy Technician, Licensed, National Certification, Audit, Auditing, Analyst, Analyze, Managed Care, PBM, Pharmacy Benefit Management, Healthcare, Pharmacy, Investigate, Investigation, UHG, UnitedHealth Group, Optum, OptumRx, CA, California, Irvine
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.