Pharmacy Audit Representative - Irvine, CA

Description UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health. 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. 
 
Pharmacy Audit Representative - Irvine, CA
 
Position Description: 
Positions in this function analyze and monitor claims against fraud, waste and abuse related to retail pharmacy and long-term care networks.
 
Primary Responsibilities:

• Investigates, reviews and analyzes 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 on-site audits at pharmacies, physician offices and long-term care facilities
• Site audits include assessment of physical premises, compliance with regulatory requirements, and completeness of provider/clinical records and itemized bills
• Identifies and documents fraudulent or erroneous activities determined as a result of an audit
• Prepares audit reports and determines overpayments
• Formal documentation may be prepared for chief compliance officer and company attorneys
• Notifies and works with 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

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.

Requirements Qualifications:

• Pharmacy Tech License required for the State of California is required
• High School Diploma or GED is required
• National Certification is preferred
• 2-3 years pharmacy experience is required, prefer 5+ years experience
• Long Term Care Pharmacy or Specialty experience required

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
 
UnitedHealth Group is a drug-free workplace.  Candidates are required to pass a drug test before beginning employment.  In addition, employees in certain positions are subject to random drug testing.