The Ohio State University Wexner Medical Center
Pharmacy Audit and Reconciliation Coordinator
The Ohio State University Wexner Medical Center, Columbus, Ohio, United States, 43224
Pharmacy Audit and Reconciliation Coordinator
4 months ago Be among the first 25 applicants Screen reader users may encounter difficulty with this site. For assistance with applying, please contact hr-accessibleapplication@osu.edu. If you have questions while submitting an application, please review these frequently asked questions.
Current Employees And Students
If you are currently employed or enrolled as a student at The Ohio State University, please log in to Workday to use the internal application process.
Welcome To The Ohio State University's Career Site. We Invite You To Apply To Positions Of Interest. In Order To Ensure Your Application Is Complete, You Must Complete The Following
Ensure you have all necessary documents available when starting the application process. You can review the additional job description section on postings for documents that may be required. Prior to submitting your application, please review and update (if necessary) the information in your candidate profile as it will transfer to your application.
Job Title
Pharmacy Audit and Reconciliation Coordinator
Department
Retail Rx | OSU Outpatient Pharmacy CCCT
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 pay understanding, payer denials and impact on revenue cycle, proactively communicate 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. This position requires strong knowledge of Microsoft Excel, Microsoft Teams and other computer related skills.
Minimum Qualifications
For Hire:
Bachelor’s in Business, healthcare or related field or equivalent combination of education and related experience or 3 years experience as a pharmacy technician. Must be registered technician with the State of Ohio Board of Pharmacy and hold active PTCB/NHA certification prior to start date.
On going:
PTCB certification and Board of Pharmacy registration as a Certified pharmacy technician must be maintained for continued employment.
Additional Information
Location:
Ackerman Rd, 660 (0242)
Position Type
Regular
Scheduled Hours
40
Shift
Varying Shifts
Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process.
Thank you for your interest in positions at The Ohio State University and Wexner Medical Center. Once you have applied, the most updated information on the status of your application can be found by visiting the Candidate Home section of this site. Please view your submitted applications by logging in and reviewing your status. For answers to additional questions please review the frequently asked questions.
The university is an equal opportunity employer, including veterans and disability. Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
Job function Accounting/Auditing and Finance Industries Hospitals and Health Care Referrals increase your chances of interviewing at The Ohio State University Wexner Medical Center by 2x Get notified about new Audit jobs in
Columbus, OH . Columbus, OH $77,154 - $120,222 1 week ago Columbus, OH $46,914 - $60,986 2 weeks ago Financial Analyst, Fixed Asset & Property Accounting - REMOTE
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4 months ago Be among the first 25 applicants Screen reader users may encounter difficulty with this site. For assistance with applying, please contact hr-accessibleapplication@osu.edu. If you have questions while submitting an application, please review these frequently asked questions.
Current Employees And Students
If you are currently employed or enrolled as a student at The Ohio State University, please log in to Workday to use the internal application process.
Welcome To The Ohio State University's Career Site. We Invite You To Apply To Positions Of Interest. In Order To Ensure Your Application Is Complete, You Must Complete The Following
Ensure you have all necessary documents available when starting the application process. You can review the additional job description section on postings for documents that may be required. Prior to submitting your application, please review and update (if necessary) the information in your candidate profile as it will transfer to your application.
Job Title
Pharmacy Audit and Reconciliation Coordinator
Department
Retail Rx | OSU Outpatient Pharmacy CCCT
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 pay understanding, payer denials and impact on revenue cycle, proactively communicate 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. This position requires strong knowledge of Microsoft Excel, Microsoft Teams and other computer related skills.
Minimum Qualifications
For Hire:
Bachelor’s in Business, healthcare or related field or equivalent combination of education and related experience or 3 years experience as a pharmacy technician. Must be registered technician with the State of Ohio Board of Pharmacy and hold active PTCB/NHA certification prior to start date.
On going:
PTCB certification and Board of Pharmacy registration as a Certified pharmacy technician must be maintained for continued employment.
Additional Information
Location:
Ackerman Rd, 660 (0242)
Position Type
Regular
Scheduled Hours
40
Shift
Varying Shifts
Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process.
Thank you for your interest in positions at The Ohio State University and Wexner Medical Center. Once you have applied, the most updated information on the status of your application can be found by visiting the Candidate Home section of this site. Please view your submitted applications by logging in and reviewing your status. For answers to additional questions please review the frequently asked questions.
The university is an equal opportunity employer, including veterans and disability. Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
Job function Accounting/Auditing and Finance Industries Hospitals and Health Care Referrals increase your chances of interviewing at The Ohio State University Wexner Medical Center by 2x Get notified about new Audit jobs in
Columbus, OH . Columbus, OH $77,154 - $120,222 1 week ago Columbus, OH $46,914 - $60,986 2 weeks ago Financial Analyst, Fixed Asset & Property Accounting - REMOTE
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr