UnitedHealth Group is among the most ambitious Fortune 25 companies you'll ever meet. Through our family of businesses, we're working to make the health care system perform better for more people, in more ways than ever.
Simply put, we think the entire system can be greater than it's ever been. And that drives us to work harder, aim higher, and expect more from one another.
Here, you'll be empowered to make an immediate impact for millions of others. And you'll achieve more than you ever expected. How does that fit with your plans?
Pharmacy Audit Analyst: Monday-Friday schedule!-314506
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Description Prescription Solutions is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
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 pharmacy teams. Let's talk about more effective and affordable health care solutions. This is caring. This is great chemistry. This is the way to make a difference.
***Shift for this position is Monday-Friday, 7:30a.m. to 4:30p.m.***
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 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.
- Carries out complex investigation research activities involving FWA for members, prescribers, and pharmacies.
- Coordinates with Management to gain appropriate levels of documentation to support audit FWA position for network provider terminations.
- Assist supervisor in coordination of desk-top and on-site audit prep, workpaper documentation standards are met, and findings summaries timely created.
- Accountable for departmental production goals as with the other auditor.
- First level of escalation for issues, and questions from staff.
- Moderate work experience within own function.- Some work is completed without established procedures.
- Basic tasks are completed without review by others.
- Supervision/guidance is required for higher level tasks.
Prescription Solutions is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. New ideas are welcome. And passion for improving the lives of our customers is a motivating factor in everything that happens. Qualifications Required::
- In-depth knowledge of pharmacy operations.
- Current and unrestricted Pharmacy Technician License.
- Minimum of 4 years experience within a Pharmacy OR PBM environment.
- Strong computer skills, specifically with Microsoft Office (Word, Excel etc...)
Preferred:
- Pharmacy Technicians with investigative experience.
- National Certification
Nice to have:
- LTC or Specialty Pharmacy experience.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
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.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. |
