Pharmacy Audit and Reconciliation Coordinator

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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.

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The university is an equal opportunity employer, including veterans and disability.

As required by Ohio Revised Code section 3345.0216, Ohio State will: educate students by means of free, open and rigorous intellectual inquiry to seek the truth; equip students with the opportunity to develop intellectual skills to reach their own, informed conclusions; not require, favor, disfavor or prohibit speech or lawful assembly; create a community dedicated to an ethic of civil and free inquiry, which respects the autonomy of each member, supports individual capacities for growth and tolerates differences in opinion; treat all faculty, staff and students as individuals, hold them to equal standards and provide equality of opportunity with regard to race, ethnicity, religion, sex, sexual orientation, gender identity or gender expression.

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