340B Audit & Compliance Analyst - Mixed-Use Pharmacy

WVU Medicine; Yorktown (VA); Sur place; USD 70 000 - 110 000; Plein temps

Résumé du poste

WVU Medicine is seeking a experienced administrator to support the 340B program, conducting audits, data analysis, and compliance across hospital and affiliated sites. The role involves maintaining 340B software, ensuring accurate mappings to charge codes, and generating regular reports for leadership.

The position requires healthcare or pharmacy experience, and certification or training in 340B operations is preferred. Strong analytical skills and attention to detail are essential for success.

Qualifications

• Requires 3 years of healthcare, finance, or pharmacy experience.
• Nationally Certified Pharmacy Technician required.
• Apexus Advanced 340B Operations Certificate preferred.
• Experience in data analysis, audit process and reporting.
• Hospital or retail pharmacy experience beneficial.

Responsabilités

• Develops systems to limit program liabilities and conducts audits to identify risk and prevent duplicate discounts and diversion.
• Monitors 340B program utilization and purchasing to ensure software and tools function correctly.
• Performs monthly compliance audits of contract pharmacies, hospital owned retail pharmacies, and hospital mixed-use pharmacy.
• Monitors eligibility for patients, providers, and locations; documents utilization and savings.
• Maintains 340B software mappings to charge codes and ensures accurate data flow.
• Uploads purchase data to 340B Split Billing Software monthly and validates mappings.
• Creates ad hoc reports to support program optimization and compliance.
• Performs targeted audits and reviews suspect pending claims for eligibility.

Connaissances

Data analysis

Audit & reporting

Confidential information handling

MS Office proficiency

Data interpretation

Formation

High School Diploma or Equivalent

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

Outils

340B Split Billing Software

Epic

MS Office (Word, PowerPoint, Excel, Outlook)

Description du poste

• 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