This job is closed
We regret to inform you that the job you were interested in has been closed. Although this specific position is no longer available, we encourage you to continue exploring other opportunities on our job board.
Optumposted 6 months ago
$48,300 - $94,500/Yr
Full-time
Remote • Irvine, CA
5,001-10,000 employees
Insurance Carriers and Related Activities
About the position
The Pharmacy Audit Analyst role at Optum involves analyzing pharmacy claims data to identify patterns of fraud, waste, abuse, and errors. This position plays a crucial role in improving health outcomes by ensuring compliance and accuracy in pharmacy benefits. The analyst will collaborate with various teams to address issues and implement solutions, while also presenting best practices to management. The role offers the flexibility to work remotely from anywhere in the U.S.
Responsibilities
- Analyze book of business to determine patterns/trends of fraud, waste, abuse and error
- Amends audit reports and determines overpayments specific to fraud, waste, abuse and errors
- Collaborates with Claims Administration and/or management in the reverse and re-billing of overpaid claims specific to fraud, waste and abuse trends
- Collaborate on proactive solutions with client, client services, and legal team related to fraud, waste and abuse matters
- Present ideas and best practices to management to address business and operational process improvements
- Coordinating audit referrals to various audit types
- Coordination of timely closure of audits
- Reviews 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 program
- Monitors and reports accordingly any compliance issues with regulatory requirement
- Identifies and documents fraudulent or erroneous activities determined as a result of a desktop or an on-site audit
- Prioritizes and organizes own work to meet agreed upon deadlines
Requirements
- Current and unrestricted Pharmacy Technician license in the state of residence
- National Pharmacy Technician Certification
- 3+ years of experience as a Pharmacy Technician
- 1+ years of experience in Pharmacy Audit
- Intermediate level of proficiency with computer skills including Microsoft Outlook, Word, and Excel
- Must be 18 years of age or older
Nice-to-haves
- 5+ years of experience as a Pharmacy Technician
- RxClaims or other pharmacy claims system experience
- Retail Pharmacy experience
- Long Term Care Pharmacy experience
- Specialty Pharmacy experience
Benefits
- 401(k) matching
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
