Senior Pharmacy Audit and Reconciliation Coordinator

Scope of Position

The Senior Pharmacy Audit and Reconciliation Coordinator at The Ohio State University Outpatient Pharmacy (OSU OP) provides expert knowledge in Medicare billing and audit requirements for pharmacy-dispensed products. This role also involves expertise in pharmacy benefit manager (PBM) audits and compliance. The ideal candidate will possess a strong understanding of retail and specialty pharmacy revenue cycle management, Medicare regulations, and will effectively utilize interpersonal, customer service, problem-solving, and collaboration skills to support pharmacy operations.

Position Summary

This position oversees Medicare and pharmacy benefit manager audit management and response, as well as the specialty and retail revenue cycle. Activities include, but are not limited to, audit and compliance for retail and specialty pharmacy claims billed to Medicare, Medicaid, and pharmacy benefit managers. It requires an expert understanding of regulatory knowledge related to billing and payment of retail, specialty, and Medicare pharmacy claims, oversight of all audits of retail and specialty prescription claims, and management of the OSU OP revenue cycle, including the escalation of complex claims and unpaid or denied claims.

This position requires a detail-oriented individual with strong analytical skills, effective communication abilities, and the capacity to collaborate with various stakeholders to ensure compliance and resolve issues efficiently. Proficiency in Microsoft Excel, Microsoft Teams, and other computer-related skills is also essential.

Minimum Qualifications

For Hire: Bachelors in Business, healthcare or related field or equivalent combination of education and related experience and 3 years of experience as a Pharmacy Audit and Reconciliation Coordinator (S2) or similar position at another Health System required. 4 to 8 years of relevant experience preferred. Must be registered technician with the State of Ohio Board of Pharmacy and hold active PTCB/NHA certification.