The Ohio State University Wexner Medical Center · 4 months ago
Pharmacy Audit and Reconciliation Coordinator
Columbus, OH
Full-time
Onsite
Mid Level
3+ years expThe Ohio State University Wexner Medical Center is seeking a Pharmacy Audit and Reconciliation Coordinator to optimize the payment cycle for pharmacy claims. This role involves ensuring accurate workflow of pharmacy accounts, reviewing payments, securing third-party payments, and maintaining compliance with payer contracts.
Health CareHospitalMedical
Responsibilities
Optimize the payment cycle for retail and specialty pharmacy claims
Ensure accurate workflow of pharmacy accounts
Review payments for accuracy and align collections with contracts
Follow up with insurance companies
Secure third-party payments and ensure compliance with payer contracts
Maintain accurate secondary billing processes and vendor data feeds
Advocate for efficient claim resolution and provide proactive follow-up
Identify trends to ensure process accuracy
Contribute to scalable process improvements
Respond to and defend audit requests from commercial health plans/payors
Ensure the accuracy and completeness of claims to retain reimbursement
Assist with revenue cycle related activities including reconciling payer remittances
Proactively communicate with onsite pharmacy staff, finance staff and insurance companies to resolve payment discrepancies
Qualification
Required
Bachelor's in Business, healthcare or related field or equivalent combination of education and related experience
3 years experience as a pharmacy technician
Must be registered technician with the State of Ohio Board of Pharmacy
Hold active PTCB/NHA certification prior to start date
PTCB certification and Board of Pharmacy registration as a Certified pharmacy technician must be maintained for continued employment
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
Strong knowledge of Microsoft Excel, Microsoft Teams and other computer related skills
Company
The Ohio State University Wexner Medical Center
The Ohio State University Wexner Medical Center is personalizing health care to meet the needs of each patient. It is a sub-organization of The Ohio State University.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Emile Daoud
Chief, Cardiac Electrophysiology Section
Recent News
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