Pharmacy Audit Analyst

Pharmacy Technician Auditor

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization 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 reside in the state of Illinois, Wisconsin, Missouri, or Tennessee, you will enjoy the flexibility to telecommute as you take on some tough challenges.

Primary Responsibilities:

This role requires nationwide travel by car, train and/or plane up to 75% of the year.

• 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 hardcopies, signature logs, compounding records, and MARs
• Facilitate answers to questions from pharmacy network providers on a rotational basis
• Report findings on 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:

• Current and unrestricted Pharmacy Technician License in the state of residence
• Must be 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
• 1+ years of experience leading in-person and virtual/desktop audits
• Intermediate level of proficiency with pharmacy operations
• Intermediate level of proficiency with Microsoft Office (Word - creating and editing documents, Excel - creating, filtering, and maintaining spreadsheets)
• Intermediate level of proficiency working independently and researching/conducting investigations
• Currently located within 45 miles of International Airport
• Currently residing in Illinois, Wisconsin, Missouri or Tennessee
• Ability to travel nationwide (car, train, plane) up to 75% of the year
• Access to reliable transportation and valid US driver's license
• Must be 18 years of age or older

Preferred Qualifications:

• 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
• Certified Quality Auditor (CQA)
• Ability to solve problems including multiple priorities and research conflicting and/or inaccurate information
• Must be self-motivated and can successfully investigate complex issues

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $48,700 to $87,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.