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Specialty Pharmacy Business Coordinator
4 weeks ago
The Specialty Pharmacy Business Coordinator plays a pivotal role in overseeing the specialty pharmacy business, ensuring seamless operations, and maintaining compliance with departmental standards, internal and external reporting requirements, accreditation standards, and pharmacy laws and regulations.
Key Responsibilities- Manage revenue cycle operations, including claims adjudication, contractual claims processing, and general reimbursement procedures.
- Engage with internal and external stakeholders to secure access to and inclusion in specialty pharmacy provider networks, accreditation, and overall business management.
- Ensure network ambulatory pharmacy claim remittances from third-party payers are received, reconciled, and posted accurately and promptly to the appropriate pharmacy account.
- Minimize aged receivable days, address underpaid claims, and resolve missing payments, collaborating closely with contracted PSAOs, HMH Reconciliation vendors, payers, and site pharmacy leaders.
- Maintain payer agreements, assist with new vendor contracting, and re-credentialing as needed with PBMs, Medicare, Medicaid, and other payers/entities.
- High School diploma, general equivalency diploma (GED), and/or GED equivalent programs.
- Minimum of three (3) years of experience in Pharmacy Claims Reconciliation.
- Comfortable using multiple software programs.
- Organized and effective time management skills.
- Clear and effective verbal and written communication.
- Detail-oriented with the ability to perform duties with the highest degree of accuracy.
- Retail or Specialty Pharmacy experience, especially claims management and reconciliation.
- Strong knowledge and experience with PBM contract completion.
This role requires a strong understanding of pharmacy operations, revenue cycle management, and payer relations. The ideal candidate will possess excellent communication and organizational skills, with the ability to work effectively in a fast-paced environment.
