This role optimizes the payment cycle for retail and specialty pharmacy claims by ensuring accurate workflow and aligning collections with contracts
Job Summary
This role optimizes the payment cycle for retail and specialty pharmacy claims by ensuring accurate workflow and aligning collections with contracts.
The specialist is responsible for securing third-party payments, maintaining secondary billing processes, and responding to audit requests from commercial health plans.
Candidates must possess advanced knowledge of state, federal, and PBM accreditation rules regarding pharmacy benefit and medical benefit claims billing.
Matching Summary
This role optimizes the payment cycle for retail and specialty pharmacy claims by ensuring accurate workflow and aligning collections with contracts.
Salary
Not specified; Not specified; Not specified
Skills & Requirements
Must-have
Pharmacy audit and reconciliation expertise
Payer remittance and unapplied cash analysis
Insurance claim denial resolution skills
Microsoft Excel and Teams proficiency
State of Ohio Board of Pharmacy registration
Nice-to-have
Proactive communication with finance staff
Trend identification for process accuracy
Experience defending commercial audit requests
Scalable process improvement contributions
Key Requirements
Bachelor's degree in Business or healthcare field
2 to 4 years of relevant experience preferred
Active PTCB/NHA certification required
Registered technician with State of Ohio Board of Pharmacy
Must maintain ongoing PTCB certification and registration