UnitedHealthcare 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.
When you work with UnitedHealthcare, what you do matters. It's that simpleand it's that challenging.
In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.
In our Pharmaceutical Solutions team in UnitedHealth Networks we are currently seeking a Manager of Financial Audit. The responsibilities of this position include, but are not limited to, the following:
1. Internal financial audits to ensure the existence and adherence to the established controls of UHPS and Medco.
2. Ensures all regulatory compliance requirements are met, including Sarbanes Oxley (SOX).
3. Determines consistency with organization's objectives and standards through various verification procedures and methods.
4. Analyze and monitor claims against fraud, waste and abuse related to retail, specialty and mail pharmacy.
5. Investigates, reviews and analyzes claims data applying knowledge of pharmacy policy and practice and data mining.
6. Supports SOX compliance processes by planning and providing employee training on SOX awareness programs.
7. Manage Audit Analyst and others conducting detail audit activities
8. UHPS liaison with Internal Audit
Directly responsible for the following Pharmacy audit activities:
- Issue Monthly Pharmacy Audit report covering all UHPS related audit activities.
- Retail pharmacy audit
- Oversight and validation of Medco quarterly audits of its retail pharmacy network: understand trends, problem areas, abuses and frauds, and validate accuracy of claims.
- PDL SOX audit: desktop level audit to ensure that changes made to the PDL were implemented accurately, completely, and timely.
- Clinical Audit: desktop level audit of clinical programs.
- Pricing Audit: desktop level audit of customer pricing arrangements.
- Prescription Audit and Audit Recovery; Audit is designed to examine Pharmacy/Member/Provider Fraud, Waste and Abuse Detection. Audit Recovery Operations conducts Retro-term recoveries, Retro Rx coordination of benefits (COB), Retro Medicaid Rx COB, and pre-payment COB following an audit or improper adjudication of a claim.
- Client Audits- UHC clients: have the ability to conduct audits of Medco as governed by certain contractually agreed to provisions within the PBS agreement between UHG and Medco. RFP data base: Subject Matter Expert for audit related RFP questions.
- Performance and Operational Guarantees Audits: desktop or field audit to measure performance of guarantees.
Regardless of your role at UnitedHealthcare, the support you feel all around you will enable you to do what you do with energy, integrity, and confidence. So take the first step in what is sure to be a fast paced and highly diversified career.
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