Job: Pharmacy Audit Representative - Irvine, CA

Jobing Description

Primary Responsibilities:

• Analyze and monitor claims against fraud, waste and abuse related to long-term care pharmacy billing such as accuracy of claims billed under Part D when member is under skilled qualifying stay or hospice.


• 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.


• Identify and document fraudulent or erroneous activities determined as a result of an audit.


• Build relationships with client and serves as the primary point of contact for overall and day-to-day service delivery.


• Formal documentation may be prepared for upper management.

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. Our service is so strong that we're recognized by J.D. Powers for being the "Highest in Customer Satisfaction with Mail Order Pharmacies."


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.

Skills / Requirements

Requirements:

• Pharmacy Tech License for the State of California is required


• High School Diploma or GED is required


• 2+ years pharmacy experience is required, 5+ years experience is preferred


• Long Term Care Pharmacy or Specialty experience is required


• National Certification is preferred

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V



UnitedHealth Group is a drug-free workplace. All candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.