1+ months

Pharmacy Audit Investigator - Remote Nationwide - 936731

Irvine, CA 92606 Work Remotely
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  • Job Code
    936731
  • Jobs Rated
    41st

Here's a statistic that will stop you cold: Our country spends nearly $3 trillion on health care annually. With that kind of money at play, you can be sure some individuals will figure out a way to get a piece of it illegally. Now, that doesn't even take into account the millions of lives that are held in the balance as well. This is fraud on a scale you couldn't begin to imagine. As aPharmacy Audit Investigator, you will play a part in putting a stop to it. It's critical work that that you will want to be a part of. Apply today.

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The challenge for you will be the high volume of cases on your plate at one time. You will be part of a team responsible for triaging, investigating and resolving instances of healthcare fraud and / or abusive conduct.

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Youll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

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Primary Responsibilities:

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  • Analyzes and monitors industry publications to be aware of fraud, waste, and abuse (FWA) schemes (PLATO, CMS / MEDIC, OIG, Google Alerts, etc.) impacting pharmacy business
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  • Perform onsite and desktop investigative audits targeting potential Pharmacy FWA
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  • Adhere to all applicable requirements for case process and quality
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  • Prepares reports and presentations based on case results
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  • Conducts onsite audits at pharmacies to assess physical premises, compliance with regulatory requirements, and completeness of records
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  • Collaborates with Manager, Sr. Investigator, and Sr. Auditors to support overall FWA prevention and detection efforts and ensure case quality
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  • Work on special projects as assigned
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  • Support the training and development of Sr. Auditors
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  • Provides ideas and recommendations on process improvements
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Youll 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.

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Required Qualifications:

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  • High school diploma / GED or higher
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  • 2+ years of experience working in pharmacy audit, PBM, healthcare investigations, or health insurance environment
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  • 1+ years pharmacy benefits management investigationsexperience
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  • 3+ years of experience in a position processing pharmacy claims and/or investigating fraud
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  • In - depth knowledge of pharmacy operations
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  • Current and unrestricted Pharmacy Technician License for the state of residence
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  • Must be currently certified by the PTCB (Pharmacy Technician Certification Board)
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  • Microsoft Office (Word - creating and editing documents, Excel - creating and maintain spreadsheets)
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  • Ability to travel up to 25% of the time
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  • Monday through Friday 6am to 3pm, 7am to 4pm or 8am to 5pm PST
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Preferred Qualifications:

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  • Bachelor's degree or higher
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  • Proficient in RxClaim and Online Reporting
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  • An 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)
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  • Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI)
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UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non-clinical workforce transitioned to a work at home (remote) status. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.

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You can learn more about all we are doing to fight COVID-19 and support impacted communities: click here.

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*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.

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Colorado Residents Only:The hourly range for Colorado residents is $43,200 to $76,700. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, in addition to your salary,UnitedHealth Groupoffers the following benefits for this position, subject to applicable eligibility requirements: health, dental and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term and long-term disability insurance; business travel accident insurance; employee assistance program; paid time off; and employee-paid critical illness and accident insurance.

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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.

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"UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment

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Keywords: Investigator, Pharmacy Tech, Pharmacy Technician, PTCB, PBM, fraud, investigations, Irvine, CA, California, Telecommute, remote, work from home, work at home, WFH, WAH, hiring immediately,#RPO

Jobs Rated Reports for Pharmacist

Posted: 2021-06-21 Expires: 2021-08-19

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

Sponsored by:
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Pharmacy Audit Investigator - Remote Nationwide - 936731

UnitedHealth Group
Irvine, CA 92606

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