Ohio State University Wexner Medical Center
Pharmacy Audit and Reconciliation Coordinator
Ohio State University Wexner Medical Center, Columbus, Ohio, United States, 43224
Scope of 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. Position Summary
This position assists with revenue cycle related activities. These activities include but are not limited to reconciling payer remittances—including unapplied cash, claim exceptions, and partial payments—understanding payer denials and their impact on the revenue cycle, and proactively communicating with onsite pharmacy staff, finance staff, and insurance companies to resolve payment discrepancies. Advanced knowledge of, or experience with, state, federal, and PBM (Pharmacy Benefit Management/commercial health plans/payors) accreditation rules and regulations regarding pharmacy benefit and medical benefit claims billing is required. This position requires strong knowledge of Microsoft Excel, Microsoft Teams, and other computer-related skills. Minimum Qualifications
For Hire:
Bachelor's degree in Business, healthcare, or a related field, or an equivalent combination of education and related experience, or 3 years of experience as a pharmacy technician. Must be a registered technician with the State of Ohio Board of Pharmacy and hold active PTCB/NHA certification prior to the start date. Ongoing:
PTCB certification and Board of Pharmacy registration as a Certified Pharmacy Technician must be maintained for continued employment.
#J-18808-Ljbffr
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. Position Summary
This position assists with revenue cycle related activities. These activities include but are not limited to reconciling payer remittances—including unapplied cash, claim exceptions, and partial payments—understanding payer denials and their impact on the revenue cycle, and proactively communicating with onsite pharmacy staff, finance staff, and insurance companies to resolve payment discrepancies. Advanced knowledge of, or experience with, state, federal, and PBM (Pharmacy Benefit Management/commercial health plans/payors) accreditation rules and regulations regarding pharmacy benefit and medical benefit claims billing is required. This position requires strong knowledge of Microsoft Excel, Microsoft Teams, and other computer-related skills. Minimum Qualifications
For Hire:
Bachelor's degree in Business, healthcare, or a related field, or an equivalent combination of education and related experience, or 3 years of experience as a pharmacy technician. Must be a registered technician with the State of Ohio Board of Pharmacy and hold active PTCB/NHA certification prior to the start date. Ongoing:
PTCB certification and Board of Pharmacy registration as a Certified Pharmacy Technician must be maintained for continued employment.
#J-18808-Ljbffr