This position optimizes the payment cycle for retail and specialty pharmacy claims by ensuring accurate workflow of pharmacy accounts
Job Summary
This position optimizes the payment cycle for retail and specialty pharmacy claims by ensuring accurate workflow of pharmacy accounts.
The specialist secures third-party payments, ensures compliance with payer contracts, and maintains accurate secondary billing processes and vendor data feeds.
Candidates must possess advanced knowledge of state, federal, and PBM accreditation rules regarding pharmacy benefit and medical benefit claims billing.
Matching Summary
This position optimizes the payment cycle for retail and specialty pharmacy claims by ensuring accurate workflow of pharmacy accounts.
Skills & Requirements
Must-have
reconciling payer remittances and unapplied cash
understanding claim exceptions and partial pay
proactive communication with insurance companies
knowledge of PBM accreditation rules and regulations
Nice-to-have
identifying trends to ensure process accuracy
contributing to scalable process improvements
defending audit requests from commercial health plans
Key Requirements
Bachelor's in Business, healthcare or related field
2 to 4 years of relevant experience preferred
Registered technician with State of Ohio Board of Pharmacy
Active PTCB/NHA certification required prior to start date