340B Audit & Compliance Analyst - Mixed-Use Pharmacy

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MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High School Diploma or Equivalent.

EXPERIENCE:

1. Three (3) years of healthcare, finance, or pharmacy experience.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Associate’s or Bachelor’s degree in Information Technology, Business Management, or Hospital Administration 

2. Nationally Certified Pharmacy Technician

3. Apexus Advanced 340B Operations Certificate

EXPERIENCE:

1. 340B Drug Pricing Program experience.

2. Experience in data analysis, audit process and reporting.

3. Hospital or retail pharmacy experience.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Develops systems and processes to limit program liabilities and provides proper audits to identify risk and prevent duplicate discounts and diversion.

2. Reviews and monitors utilization records and 340B purchasing accounts to ensure software or tools are working properly and accurately, performing audits or compliance assessments to validate processes.

3. Monitors monthly and annual reports on 340B Program participation which clearly documents utilization, savings, problem areas and exceptions or discrepancies.

4. Performs monthly compliance audits of contract pharmacies, hospital owned retail pharmacies, specialty pharmacies and hospital mixed use pharmacy to ensure that all 340B HRSA regulations are upheld.

5. Performs monthly compliance audits of patient eligibility, provider eligibility, and location eligibility.

6. Monitors purchasing records where 340B participation occurs, clearly documenting utilization, savings, problem areas and exceptions or discrepancies, to be shared with pharmacy leadership, Finance and Administration.

7. Maintains 340B Program software to ensure appropriate products are mapped to the appropriate charge code and in the correct ratio as well as maintain system when new charge codes are created.

8. Responsible for daily maintenance of the 340B Split Billing Software. Responsible for the testing and validation of the 340B Split Billing Software and it’s communication with pharmacy software.

9. Monitors purchases for contract compliance, 340B compliance, and accurate pricing.

10. Assists WVUHS covered entities with reporting, data requests and other inquiries as necessary.

11. Responsible for uploading purchase data to 340B Split Billing Software on a monthly basis for all purchases made outside of the wholesaler.

12. Performs monthly audit to verify mapping is correct in the 340B Split Billing Software.

13. Provides purchaser(s) throughout the system with information and assistance needed to place orders using the appropriate accounts to maximize the 340B benefit.

14. Reviews product accumulation is split-billing software to ensure proper accumulations and identify negative trends.

15. Reviews ineligible claim data to ensure maximum benefit and identification of third-party administrator claim processing issues. 

16. Responsible for single dose vial reporting and monthly input of single dose vial waste into split-billing software.

17. Responsible for updating any changes to charge code billing units from Epic into the split-billing software for accuracy and consistency.

18. Creates ad hoc reports to support program optimization and compliance.

19. Performs targeted audits, negative audits, referral process development and reviews suspect pending claims to find additional eligibility.

20. Completes accumulator reviews and targeted audits to ensure compliance.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this position, the employee may be required to sit for long periods of time.

2. Extended periods of computer and telephone usage.

3. Must be able to move throughout the department work areas.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment.

SKILLS AND ABILITIES:

1. Ability to handle and maintain confidential information.

2. Ability to work independently or cooperatively as a team member.

3. Ability to adapt to various workloads and assignments.

4. Must possess analytical and problem-solving skills.

5. Must have effective verbal and written communication skills, as well as interpersonal skills necessary to communicate effectively with all levels of management.

6. Ability to interpret and analyze data.

7. Understanding basic computer programs and knowledge of MS Office applications including Word, PowerPoint, Excel and Outlook.

Additional Job Description:

Scheduled Weekly Hours:

Shift:

Exempt/Non-Exempt:

Company:

Cost Center: