Pharmacy Audit and Reconciliation Coordinator
About The Position
The Revenue Integrity Specialist optimizes the payment cycle for retail and specialty pharmacy claims. This role ensures accurate workflow of pharmacy accounts, reviews payments for accuracy, aligns collections with contracts, and follows up with insurance companies. The specialist secures third-party payments, ensures compliance with payer contracts, and maintains accurate secondary billing processes and vendor data feeds. They advocate for efficient claim resolution, provide proactive follow-up, and identify trends to ensure process accuracy. Additionally, they contribute to scalable process improvements, respond to and defend audit requests from commercial health plans/payors, and ensure the accuracy and completeness of claims to retain reimbursement. The Ohio State University (OSU) Outpatient Pharmacy’s mission is to improve people’s lives through pharmacy practice innovation, comprehensive medication education, and collaborative clinical and practice research. The OSU Outpatient Pharmacy generates more $250M in annual revenue and processes more than 250,000 claims at 8 pharmacy locations. This position will provide claims reconciliation, claims filing, audit support and response and reimbursement challenges for all 8 OSU Outpatient Pharmacy sites.
Requirements
- Bachelor's Degree or equivalent combination of education and experience.
- Certified Pharmacy Technician.
- 2 years of relevant experience required.
Nice To Haves
- 2-4 years of relevant experience preferred.
Responsibilities
- Optimizes the payment cycle for retail and specialty pharmacy claims.
- Ensures accurate workflow of pharmacy accounts.
- Reviews payments for accuracy.
- Aligns collections with contracts.
- Follows up with insurance companies.
- Secures third-party payments.
- Ensures compliance with payer contracts.
- Maintains accurate secondary billing processes and vendor data feeds.
- Advocates for efficient claim resolution.
- Provides proactive follow-up.
- Identifies trends to ensure process accuracy.
- Contributes to scalable process improvements.
- Responds to and defends audit requests from commercial health plans/payors.
- Ensures the accuracy and completeness of claims to retain reimbursement.
- Provides claims reconciliation, claims filing, audit support and response and reimbursement challenges for all 8 OSU Outpatient Pharmacy sites.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
