The Revenue Integrity Specialist optimizes the payment cycle for retail and specialty pharmacy claims, ensuring accurate workflow and payment accuracy
Job Summary
The Revenue Integrity Specialist optimizes the payment cycle for retail and specialty pharmacy claims, ensuring accurate workflow and payment accuracy.
This role involves reconciling payer remittances, understanding claim exceptions, and proactively communicating with stakeholders to resolve payment discrepancies.
The specialist must defend against audit requests from commercial health plans/payors and ensure claim accuracy to retain reimbursement.
Matching Summary
The Revenue Integrity Specialist optimizes the payment cycle for retail and specialty pharmacy claims, ensuring accurate workflow and payment accuracy.
Skills & Requirements
Must-have
pharmacy claims reconciliation
revenue cycle management
payer remittance review
insurance follow-up
Microsoft Excel proficiency
Nice-to-have
proactive communication
process improvement identification
scalable process development
Key Requirements
2 years of relevant experience
Registered technician with State of Ohio Board of Pharmacy
Active PTCB/NHA certification
Bachelor's in Business, healthcare or related field or equivalent combination of education and experience