Pharmacy Audit and Reconciliation Coordinator

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Job Title:

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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

The Ohio State University (OSU) Outpatient Pharmacy’s mission is to improve people’s lives through pharmacy practice innovation, comprehensive medication education, and collaborative clinical and practice research. The OSU Outpatient Pharmacy generates more $250M in annual revenue and processes more than 250,000 claims at 8 pharmacy locations. This position will provide claims reconciliation, claims filing, audit support and response and reimbursement challenges for all 8 OSU Outpatient Pharmacy sites.

Minimum Qualifications

Bachelor's Degree or equivalent combination of education and experience. Certified Pharmacy Technician. 2 years of relevant experience required. 2-4 years of relevant experience preferred.

Additional Information:

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