We're 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.(sm)
Positions in this function analyze and monitor real-time pharmacy claims against fraud, waste, abuse and errors related to retail pharmacy and long-term care networks. Review system flagged claim for issue type and risk score, follow up with dispensing pharmacy to determine if claim was processed with missing or inaccurate information, send update to data as appropriate. Investigate, review and analyze 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 desktop and on-site audits at pharmacies and long-term care facilities pharmacies. Site audits include assessment of physical premises, compliance with federal and state regulatory requirements and completeness of pharmacy licenses, policies and procedures, prescription records and wholesaler itemized invoices. Identify and document fraudulent or erroneous activities determined as a result of an audit. Prepare audit reports and determine overpayments. Formal, ongoing documentation and reports may be prepared for clients, chief compliance officer and company attorneys. Notify and work with various 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.
- 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.
- Audit Prescription Claims from US
Requirement:
Must be a Registered Pharmacist with active licenseCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do 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.