The Revenue Integrity Specialist optimizes the payment cycle for retail and specialty pharmacy claims, ensuring accurate workflow and verifying payments against contracts
Job Summary
The Revenue Integrity Specialist optimizes the payment cycle for retail and specialty pharmacy claims, ensuring accurate workflow and verifying payments against contracts.
This role involves following up with insurance companies, securing third-party payments, and maintaining accurate secondary billing processes.
The specialist will respond to and defend audit requests from commercial health plans/payors, ensuring the accuracy and completeness of claims to retain reimbursement.
Matching Summary
The Revenue Integrity Specialist optimizes the payment cycle for retail and specialty pharmacy claims, ensuring accurate workflow and verifying payments against contracts.
Skills & Requirements
Must-have
pharmacy claims reconciliation
payer remittance analysis
insurance company follow-up
Microsoft Excel proficiency
Microsoft Teams proficiency
Nice-to-have
proactive communication
scalable process improvements
efficient claim resolution advocacy
Key Requirements
2 years relevant experience required
Registered technician with State of Ohio Board of Pharmacy
Active PTCB/NHA certification prior to start date
Bachelor's in Business, healthcare or related field or equivalent experience