Senior Pharmacy Audit Representative - Hybrid in San Antonio, TX

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Schedule: Hybrid schedule - Monday to Friday, between 7 AM -6 PM, 40 hrs/week.

3 days in office: Tues-Thurs, every other week

Location: Onsite - 19500 W Interstate 10 Bldg 2, San Antonio, TX 78257

The Senior Pharmacy Audit Representative will work on a wide range of activities to support pharmacy operations and initiatives to help meet goals and deliverables. Conducts audits of pharmacy claims in alignment with prior authorization requests and conducts audits of various pharmacy initiatives. Responsible for gathering and evaluating data from multiple sources to support ongoing pharmacy daily operations. Assist pharmacy leadership with business process and policy development of programs and productivity metrics. Assist with report development and analysis to support key initiatives and operations.

If you live near San Antonio, TX, you will enjoy the flexibility of a hybrid-remote role as you take on some tough challenges.

Primary Responsibilities:

• Supports daily operations for high volume of pharmacy pre-service requests for high-cost Part B drugs
• Assist in analyzing and monitoring pharmacy claims against fraud, waste, abuse and errors related to claims processed for Part B drugs
• Assist in conducting audits of pharmacy initiatives to ensure daily work aligns with established policies and job aids
• Conduct audits of systems to ensure alignment of system configurations and prior authorization requirements
• Coordinate, track, and report out results of user acceptance testing across multiple systems
• Assists in the development of tools to track operational metrics and monitor current initiatives
• May answer inbound calls from internal and external customers and assists them with their inquiries and routes calls to appropriate department if necessary
• Coordinates with all team members to keep workflow/initiatives on track
• Performs audit of staff documentations to ensure accuracy of the information documented as well as standard processes are followed
• Performs desk and on-site review of claims documentation to validate pharmacy processes and correct payment made to contracted providers
• Assists leadership and other related department team members in the implementation of programs or projects, including planning, developing, implementing and evaluating programs and projects, coordinating project activities, collaborating with project team members, and monitoring progress toward achievement and other projects as assigned
• Prepares draft agendas for meetings for review with leadership and assists with scheduling necessary meetings with team and other stakeholders
• Records minute and takes detailed notes during meetings and provides follow-up correspondence
• Prepares reports, presentations, verbal/written correspondences, policies, communications, procedures and other required documentation as instructed by leadership
• Performs moderately complex business operation analysis and conducts research, analyzes/interprets information on issues, proposals and problems to ensure that adequate data is provided to leadership for decision-making and informational purposes
• Analyzes processes and presents findings to functional leads to develop or improve processes, services and/or programs to support the goals of the enterprise
• Manages multiple tasks at one time with successful outcomes
• Able to serve as a liaison between business and IT to document business and /or technical requirements
• Performs all other related duties as assigned

You'll 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.

Required Qualifications:

• High School Diploma / GED (or higher)
• +1 years of experience in process improvement initiatives
• Advance level of knowledge with Microsoft Office applications to include Word, Excel, Visio, PowerPoint and Outlook (Process flow mapping, pivot tables, vlookup, etc)
• Intermediate level knowledge of HIPAA Privacy and Security Rules and CMS security requirements
• Intermediate level knowledge of SharePoint
• Beginner level of knowledge of Medicare Part B and Part D coverage guidelines and payment methodologies
• Ability to independently solve moderately complex problems
• Ability to work in a fast-paced environment on multiple projects with tight deadlines while paying close attention to the details of all the deliverables
• Ability to plan, prioritize, organize and complete complex work efforts to meet established objectives
• Ability to successfully develop action plans and execute the plan through implementation

Preferred Qualifications:

• Associate's Degree in Business
• 2+ years of experience with tracking, planning projects, and making data-driven analytical decisions
• Experience in customer service or healthcare related field
• Project Management experience
• Previous auditing experience
• Experience with process mapping methodology and creating process maps
• Health plan, healthcare or clinic operations experience

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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

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