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 denials, and proactively communicating to resolve payment discrepancies.
The position requires advanced knowledge of state, federal, and PBM accreditation rules and regulations regarding pharmacy and medical benefit claims billing.
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
payer remittances
claim exceptions
payer denials
third-party payments
payer contracts
Nice-to-have
proactive follow-up
scalable process improvements
audit defense
Key Requirements
Bachelor’s in Business, healthcare or related field or equivalent combination of education and related experience
2 years of relevant experience
Registered technician with the State of Ohio Board of Pharmacy