What are the responsibilities and job description for the Pharmacy Audit and Reconciliation Specialist position at osu?
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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 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 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. 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, 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. 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. At Ohio State, you’ll find work that inspires you. We offer roles and growth opportunities in countless fields and specialties — including a job that’s right for you. Ohio State benefits give you options to take care of what matters most to you — and opportunities to make adjustments as your life and needs change, including: • Medical, dental and vision coverage, with Ohio State paying a significant portion of the cost. • Paid time off, including sick and vacation time and 11 holidays. • State retirement plan or an alternative retirement plan, both with generous employer contributions. As Buckeyes, we accomplish more together. No matter your role, you’ll be part of creating what people need now: pathways to education, research and health care. 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