340B Audit & Compliance Analyst - Mixed-Use Pharmacy

WVU Medicine; Virginia; On-site; USD 90,000 - 120,000; Full time

Job summary

WVU Medicine seeks an experienced 340B Pharmacy Administrator to ensure compliance and optimize the 340B program across hospital and contract pharmacies. You will lead audits, data reporting, and system maintenance to maximize savings while preventing liabilities.

The role requires a High School Diploma or Equivalent, 3 years of healthcare/finance/pharmacy experience, and an Associate’s or Bachelor’s degree in IT, Business Management, or Hospital Administration; certification as a Pharmacy

Qualifications

• High School Diploma or Equivalent.
• Three (3) years of healthcare, finance, or pharmacy experience.
• Associate’s or Bachelor’s degree in Information Technology, Business Management, or Hospital Administration
• Nationally Certified Pharmacy Technician
• Experience in data analysis, audit process and reporting.
• Hospital or retail pharmacy experience.
• Develops systems and processes to limit program liabilities and provides proper audits to identify risk and prevent duplicate discounts and diversion.
• 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.
• Monitors monthly and annual reports on 340B Program participation which clearly documents utilization, savings, problem areas and exceptions or discrepancies.
• 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.
• Performs monthly compliance audits of patient eligibility, provider eligibility, and location eligibility.
• 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.
• 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.
• 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.
• Monitors purchases for contract compliance, 340B compliance, and accurate pricing.
• Assists WVUHS covered entities with reporting, data requests and other inquiries as necessary.
• Responsible for uploading purchase data to 340B Split Billing Software on a monthly basis for all purchases made outside of the wholesaler.
• Performs monthly audit to verify mapping is correct in the 340B Split Billing Software.
• Provides purchaser(s) throughout the system with information and assistance needed to place orders using the appropriate accounts to maximize the 340B benefit.
• Reviews product accumulation is split-billing software to ensure proper accumulations and identify negative trends.
• Reviews ineligible claim data to ensure maximum benefit and identification of third-party administrator claim processing issues.
• Responsible for single dose vial reporting and monthly input of single dose vial waste into split-billing software.
• Responsible for updating any changes to charge code billing units from Epic into the split-billing software for accuracy and consistency.
• Creates ad hoc reports to support program optimization and compliance.
• Performs targeted audits, negative audits, referral process development and reviews suspect pending claims to find additional eligibility.
• Completes accumulator reviews and targeted audits to ensure compliance.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Extended periods of computer and telephone usage.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Ability to handle and maintain confidential information.
• Ability to interpret and analyze data.
• Understanding basic computer programs and knowledge of MS Office applications including Word, PowerPoint, Excel and Outlook.

Responsibilities

• Monitors 340B program activities for compliance and optimization.
• Maintains software mappings and charge codes for accuracy.
• Performs monthly audits of contract and hospital pharmacies for HRSA compliance.
• Generates ad hoc reports to support program improvements and decision making.
• Assists leadership with data requests and 340B reporting needs.

Skills

Data analysis

Auditing

Reporting

Confidential information handling

Analytical skills

Education

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

Nationally Certified Pharmacy Technician

Tools

MS Office (Word, PowerPoint, Excel, Outlook)

Job description

• High School Diploma or Equivalent.
• Three (3) years of healthcare, finance, or pharmacy experience.
• Associate’s or Bachelor’s degree in Information Technology, Business Management, or Hospital Administration
• Nationally Certified Pharmacy Technician
• Apexus Advanced 340B Operations Certificate
• Experience in data analysis, audit process and reporting.
• Hospital or retail pharmacy experience.
• Develops systems and processes to limit program liabilities and provides proper audits to identify risk and prevent duplicate discounts and diversion.
• 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.
• Monitors monthly and annual reports on 340B Program participation which clearly documents utilization, savings, problem areas and exceptions or discrepancies.
• 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.
• Performs monthly compliance audits of patient eligibility, provider eligibility, and location eligibility.
• 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.
• 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.
• 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.
• Monitors purchases for contract compliance, 340B compliance, and accurate pricing.
• Assists WVUHS covered entities with reporting, data requests and other inquiries as necessary.
• Responsible for uploading purchase data to 340B Split Billing Software on a monthly basis for all purchases made outside of the wholesaler.
• Performs monthly audit to verify mapping is correct in the 340B Split Billing Software.
• Provides purchaser(s) throughout the system with information and assistance needed to place orders using the appropriate accounts to maximize the 340B benefit.
• Reviews product accumulation is split-billing software to ensure proper accumulations and identify negative trends.
• Reviews ineligible claim data to ensure maximum benefit and identification of third-party administrator claim processing issues.
• Responsible for single dose vial reporting and monthly input of single dose vial waste into split-billing software.
• Responsible for updating any changes to charge code billing units from Epic into the split-billing software for accuracy and consistency.
• Creates ad hoc reports to support program optimization and compliance.
• Performs targeted audits, negative audits, referral process development and reviews suspect pending claims to find additional eligibility.
• Completes accumulator reviews and targeted audits to ensure compliance.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Extended periods of computer and telephone usage.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Ability to handle and maintain confidential information.
• Ability to interpret and analyze data.
• Understanding basic computer programs and knowledge of MS Office applications including Word, PowerPoint, Excel and Outlook.
• 40 Shift:
• 248 SYSTEM 340B Pharmacy Admin