About the Company
OptumRx, a UnitedHealth Group company, is a leading pharmacy benefit manager dedicated to making health care work better for everyone. We help millions of people access the medications they need, providing innovative solutions to improve health outcomes and manage costs. Our team is driven by a commitment to accuracy, efficiency, and patient well-being, fostering a culture of continuous improvement and support.
Job Description
We are seeking a highly meticulous and dedicated Pharmacy Auditing Clerk to join our remote team. In this critical role, you will be responsible for reviewing pharmacy claims, invoices, and dispensing records to ensure compliance with contractual agreements, regulatory requirements, and internal policies. The ideal candidate will possess exceptional attention to detail, strong analytical skills, and a commitment to maintaining the highest standards of accuracy in a fast-paced environment. This is a 100% remote position, offering flexibility and the opportunity to contribute significantly to our operational integrity.
Key Responsibilities
- Perform comprehensive audits of pharmacy claims and related documentation for accuracy and compliance.
- Verify adherence to contract terms, pricing agreements, and regulatory guidelines (e.g., HIPAA, state pharmacy laws).
- Identify discrepancies, errors, and potential fraud or abuse patterns in billing and dispensing.
- Prepare detailed audit reports outlining findings, recommendations, and corrective actions.
- Communicate effectively with internal teams and external pharmacy partners regarding audit results and necessary adjustments.
- Maintain accurate records of all audit activities and findings.
- Assist in the development and refinement of auditing procedures and tools.
- Participate in ongoing training to stay current with industry trends, regulations, and company policies.
Required Skills
- Exceptional attention to detail and accuracy
- Strong analytical and problem-solving abilities
- Proficiency in Microsoft Office Suite (Excel, Word, Outlook)
- Excellent written and verbal communication skills
- Ability to work independently and manage time effectively in a remote setting
- Prior experience with data entry and record-keeping
- Understanding of basic pharmacy terminology and processes
Preferred Qualifications
- 1+ years of experience in pharmacy operations, medical billing, or auditing role
- Associate's or Bachelor's degree in a related field
- Experience with pharmacy management software or claims processing systems
- Knowledge of PBM (Pharmacy Benefit Manager) operations and contracts
Perks & Benefits
- Competitive salary and performance-based bonuses
- Comprehensive health, dental, and vision insurance
- 401(k) retirement plan with company match
- Paid time off and company holidays
- Life insurance and disability benefits
- Employee assistance program
- Opportunities for professional development and career advancement
- Fully remote work model with flexible scheduling options
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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