Audit & Oversight Technician
7 days left
- Employment Status
- Full Time
Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.
ABOUT UCAREAt UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities. WORKING AT UCAREWorking at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do. AUDIT AND OVERSIGHT TECHNICIAN Position DescriptionThis position will collaborate within the pharmacy team and with UCare departments to provide oversight of pharmacy benefits and claims processing across all lines of business. This position is responsible for both auditing and monitoring; as well as for the coordination of audits and monitoring events to strengthen regulatory compliance, support clinical program administration, and optimize regulatory efficiency across the pharmacy department. This role requires strong analytical, problem-solving and communication skills and the ability to assimilate information and data from multiple sources. Specific duties and responsibilities include: Maintain a strong understanding of UCare products, benefits, pharmacy operations, and clinical programs; including formulary knowledge, benefit management, regulatory oversight, and appropriate drug claims processing (Medical and Pharmacy). Perform data analysis to ensure drug claims are processing appropriately according to the formulary and benefits structure (both internally and through the PBM processing system); and research to resolve any identified issues in a timely and professional matter. Perform audits of pharmacy data. UCare participates in several audits throughout the year as determined through regulatory requirements, Corrective Action outlines, and as necessary based on clinical and operational oversight. Lead or act as department lead on audits requiring pharmacy data. Coordinate all aspects of audits within the pharmacy team, with our PBM, and cross departmentally where necessary. Perform oversight of required pharmacy data, lead the coordination of action and response; and address outcomes as necessary.Lead oversight of the PBM as it relates to pharmacy audits and ongoing oversight of day to day claims processing.Assist with the development, analysis, and processing of both ad-hoc and regulatory required reporting and audits on pharmacy data. Apply knowledge and skills to a range of other assignments requiring collaboration within pharmacy, the PBM and across UCare functional departments. Other projects and duties as assigned.EducationCertified pharmacy technician, registered in the State of MN. BA/BS preferred; demonstrated experience may be considered in lieu of a degree.Required ExperienceThree years experience in health care pharmacy setting. Detailed pharmacy claims processing and / or audit experience.Preferred ExperienceMedicare Part D, State Public Programs and Healthcare Reform knowledge. Proficiency in pharmacy data analysis and validation. Strong working proficiency with MS office products. THE UCARE DIFFERENCEUCare is proud to be a recognized Star Tribune Top Workplace for the 7th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply. As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.