340B Compliance Auditor I

Geisinger; Danville (PA); On-site; USD 65,000 - 90,000; Full time

Job description

Job Summary

Responsible for achieving in-depth knowledge of the 340B Program and providing expert audit direction to staff and management regarding the 340B Program. Maintains up-to-date knowledge of Geisinger’s 340B eligible locations, contract pharmacy network, procedures on 340B purchasing processes, and provides accurate and efficient audits to identify risk and prevent duplicate discounts and diversion. Routinely reviews 340B Program policies and procedures and offers contributions and changes to ensure 340B compliance. The individual will work collaboratively with the 340B Program Manager and 340B Program Director, and other stakeholders to lead comprehensive audits and internal controls for 340B, as well as support departmental revenue cycle and other key initiatives.

Job Duties

• Ensures compliance with 340B drug purchasing, monthly auditing, split-billing software maintenance, contract pharmacy and mixed-use audits, and all areas of program compliance.
• Performs audits on a scheduled basis; to ensure compliance with the federal regulations of the 340B program, may involve presenting and resolving reconciliation issues as they arise during the monitoring and reconciliation process.
• Evaluates patient eligibility for qualified and non-qualified patients by reviewing patient medical records, insurance plans, and hospital admission status. Perform chart and medical record review to verify necessary patient, provider, and medication information to ensure proper claim submission, and maintain accurate documentation of records related to 340B program.
• Ensures standard operating procedures are being followed and monitor all drug purchases on the GPO, WAC, and 340B accounts. Professionally interact with multiple 340B program affiliates, including wholesalers, vendors, information system service providers, insurance providers, internal and contracted pharmacies, internal departments, medical providers, and external auditors.
• Monitors compliance across points of service where 340B participation occurs.
• Reviews processes to minimize risk and prevent duplicate discounts or diversion.
• Ensures continuous compliance with federal 340B regulations.
• Split-Billing and Contract Pharmacy Software Maintenance: Develop a thorough understanding of split-billing systems and perform basic crosswalk maintenance.
• Performs spot audits and compliance assessments to confirm accuracy of charge descriptions, utilization data, and reorder reporting.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Position Details

Education: High School Diploma or Equivalent (GED) - (Required)

Experience: Minimum of 2 years-Related work experience (Required)

OUR PURPOSE & VALUES

Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all.

We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.