Pharmacy Audit And Reconciliation Specialist

The Ohio State University

Columbus, OH, US
Onsite
Pharmacy benefit management rules knowledge
Microsoft excel and teams proficiency
Payer contract compliance expertise
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 is responsible for defending audit requests from commercial health plans and ensuring the accuracy of claims to retain reimbursement.
  • Candidates must possess advanced knowledge of state, federal, and PBM accreditation rules regarding pharmacy benefit billing.

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

  • Pharmacy Benefit Management rules knowledge
  • Microsoft Excel and Teams proficiency
  • Payer contract compliance expertise
  • Third-party payment collection skills

Nice-to-have

  • Proactive communication with finance staff
  • Trend identification for process accuracy
  • Scalable process improvement contributions

Key Requirements

  • Bachelor's degree in Business or Healthcare
  • 2-4 years relevant experience preferred
  • Registered Ohio Board of Pharmacy technician
  • Active PTCB or NHA certification required
  • Must maintain ongoing certification for employment

Work Rights

Not specified

Tailored Resume

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