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 advocate for efficient claim resolution, respond to audit requests from commercial health plans, and defend reimbursement accuracy.
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
resolving claim exceptions and partial payments
managing payer denials and revenue impact
communicating with insurance companies and staff
maintaining secondary billing processes
Nice-to-have
identifying trends to ensure process accuracy
contributing to scalable process improvements
proactive follow-up on claim resolution
Key Requirements
Bachelor's in Business, healthcare or related field
2 years of relevant experience required
Registered technician with State of Ohio Board of Pharmacy
Active PTCB or NHA certification prior to start date