Pharmacy Audit and Reconciliation Coordinator

The Ohio State University Wexner Medical Center

Columbus (OH)

On-site

USD 46,914 - 120,222

Full time

14 days+

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Job summary

A leading healthcare institution is hiring a Pharmacy Audit and Reconciliation Coordinator to manage the pharmacy claims workflow and drive revenue cycle improvements. This role requires a combination of technical skills in billing and experience as a pharmacy technician, ensuring compliance with industry regulations. Successful candidates will have strong analytical and communication skills, and a commitment to maintaining accurate and efficient claims processing.

Qualifications

Must be registered technician with the State of Ohio Board of Pharmacy.
Hold active PTCB/NHA certification prior to start date.
3 years experience as a pharmacy technician or equivalent required.

Responsibilities

Optimizes the payment cycle for pharmacy claims.
Ensures accurate workflow and follows up with insurance companies.
Contributes to scalable process improvements in revenue cycle.

Skills

Advanced knowledge of pharmacy benefit billing

Microsoft Excel

Microsoft Teams

Education

Bachelor’s in Business, healthcare or related field

Job description

Pharmacy Audit and Reconciliation Coordinator

4 months ago Be among the first 25 applicants

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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.

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