About the Company
Optum, a part of UnitedHealth Group, is a leading health services innovation company committed to helping people live healthier lives and helping make the health system work better for everyone. We combine technology, data, and expertise to improve the delivery, quality, and efficiency of healthcare. Join our team dedicated to making a difference in the healthcare industry.
Job Description
We are seeking a highly accurate and detail-oriented Pharmacy Auditing Clerk to join our remote team. In this critical role, you will be responsible for meticulously reviewing pharmacy claims, ensuring compliance with established policies, procedures, and regulatory requirements. This position plays a vital part in maintaining the integrity of our pharmacy data and processes, directly contributing to efficient operations and accurate financial reporting. Success in this role requires exceptional attention to detail, strong analytical skills, and a commitment to precision.
Key Responsibilities
- Conduct thorough audits of pharmacy claims, prescriptions, and related documentation to ensure accuracy and compliance.
- Identify discrepancies, errors, or non-compliant issues in claim submissions and escalate as necessary.
- Verify adherence to prior authorization requirements, formulary guidelines, and benefit limits.
- Maintain detailed records of audit findings and corrective actions taken.
- Collaborate with internal teams to resolve identified issues and implement preventative measures.
- Stay current with industry regulations, coding standards, and pharmacy benefit management (PBM) policies.
- Prepare comprehensive reports on audit results and trends.
- Participate in process improvement initiatives to enhance audit efficiency and effectiveness.
Required Skills
- Exceptional attention to detail and accuracy.
- Strong analytical and problem-solving abilities.
- Proficiency in data entry and experience with Microsoft Office Suite (Excel, Word).
- Excellent written and verbal communication skills.
- Ability to work independently in a remote environment with minimal supervision.
- Strong organizational and time management skills.
Preferred Qualifications
- Previous experience in a healthcare, pharmacy, or claims auditing role.
- Familiarity with medical and pharmacy terminology, CPT codes, and ICD-10 coding.
- Experience with pharmacy benefit management (PBM) systems or claims processing software.
- Associate's or Bachelor's degree in a related field.
Perks & Benefits
- Comprehensive health, dental, and vision insurance.
- 401(k) retirement plan with company match.
- Paid time off (PTO) and company holidays.
- Life insurance and disability benefits.
- Employee assistance program (EAP).
- Opportunities for professional development and career growth.
- Flexible work environment.
How to Apply
If you are interested in this position, please click the "Apply Now" button below. To ensure your application is properly considered, please prepare the following:
- An up-to-date Resume or CV
- A brief cover letter summarizing your experience and motivation
Applications are reviewed on a rolling basis. Only shortlisted candidates will be contacted for an interview.
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