Pharmacy Audit and Reconciliation Specialist
The Ohio State University, Columbus, OH, United States
Job Title: Pharmacy Audit and Reconciliation Specialist
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 communicating with onsite pharmacy staff, finance staff and insurance companies to resolve payment discrepancies. Advanced knowledge of, or experience with, state, federal and PBM 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 in Business, healthcare or related field or equivalent combination of education and related experience or 2 years of relevant experience required. 2 to 4 years of relevant experience preferred. Must be registered technician with the State of Ohio Board of Pharmacy and hold active PTCB/NHA certification prior to start date.
Ongoing: PTCB certification and Board of Pharmacy registration as a Certified pharmacy technician must be maintained for continued employment.
Additional Information Location: Ackerman Rd, 600 (2435)
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.
The university is an equal opportunity employer, including veterans and disability.
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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 communicating with onsite pharmacy staff, finance staff and insurance companies to resolve payment discrepancies. Advanced knowledge of, or experience with, state, federal and PBM 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 in Business, healthcare or related field or equivalent combination of education and related experience or 2 years of relevant experience required. 2 to 4 years of relevant experience preferred. Must be registered technician with the State of Ohio Board of Pharmacy and hold active PTCB/NHA certification prior to start date.
Ongoing: PTCB certification and Board of Pharmacy registration as a Certified pharmacy technician must be maintained for continued employment.
Additional Information Location: Ackerman Rd, 600 (2435)
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.
The university is an equal opportunity employer, including veterans and disability.
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