Supervisor of Pharmacy Audit: Monday-Friday schedule! - (US-CA-Irvine - 92710)

Minimum Education: None
Jobcode: 60022974
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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.
 
***Shift for this position is Monday-Friday, 7:30a.m. to 4:30p.m.***  
 
Responsibilities:

• Positions in this function analyze and monitor claims against fraud, waste and abuse related to retail pharmacy and long-term care networks.


• 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.  


• Coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit.


• Responsible for meeting production quotas and performance guidelines of staff, maintenance of department systems, and adherence to corporate and departmental P&P's.


• Supervision of up to 7 direct reports.


• Train new associates on all systems and reporting.


• Ensure smooth workflow of daily audit routines and report resolution.


• Ability to generate all required internal and external reporting.


• Responsible for monthly production goal.


• Participates in Escalation Oversight Committee meetings.


• Assist Manager in duties and re-prioritizations of in-depth audit workload.


• Assist in departmental education.


• Other duties as assigned by Management.

Required:

• In-depth knowledge of pharmacy operations.


• Current and unrestricted Pharmacy Technician License.


• Minimum 4-5 years progressive work experience in PBM environment OR minimum 5 years of pharmacy experience.


• Strong computer skills, specifically with Microsoft Office (Word, Excel etc...)

Preferred:

• Pharmacy Technicians with investigative experience.


• National Certification.


• Supervisory experience.