Pharmacy Audit And Reconciliation Specialist

The Ohio State University

Columbus, OH, US
Onsite
Advanced knowledge of microsoft excel
Experience with payer remittance reconciliation
Understanding of pbm accreditation rules
This role optimizes the payment cycle for retail and specialty pharmacy claims by ensuring accurate workflow of pharmacy accounts

Job Summary

  • This role 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.
  • Candidates must advocate for efficient claim resolution and respond to audit requests from commercial health plans.

Matching Summary

This role optimizes the payment cycle for retail and specialty pharmacy claims by ensuring accurate workflow of pharmacy accounts.

Skills & Requirements

Must-have

  • Advanced knowledge of Microsoft Excel
  • Experience with payer remittance reconciliation
  • Understanding of PBM accreditation rules

Nice-to-have

  • Proactive communication with insurance companies
  • Ability to identify revenue cycle trends
  • Experience defending audit requests

Key Requirements

  • Bachelor's degree in Business or Healthcare
  • 2 to 4 years of relevant experience preferred
  • Registered technician with State of Ohio Board of Pharmacy
  • Active PTCB or NHA certification required prior to start

Work Rights

Not specified

Tailored Resume

Cover Letter