340B Compliance Auditor I

Geisinger; Pennsylvania; Hybrid; USD 70,000 - 95,000; Full time

Job summary

Geisinger is seeking a 340B Compliance professional to ensure program integrity across audits, reconciliation, and documentation.

The role involves reviewing patient eligibility, verifying claim data, and maintaining SOPs for GPO, WAC, and 340B accounts. You will interact with multiple stakeholders including internal departments and external auditors to uphold regulatory standards.

Qualifications

• Auditing and monitoring of 340B program compliance.
• Knowledge of federal 340B regulations and policy requirements.
• Documentation practices for 340B records and claims.

Responsibilities

• Conduct scheduled audits to ensure compliance with federal 340B regulations.
• Resolve reconciliation issues during monitoring and reconciliation processes.
• Review patient eligibility, medical records, and insurance for proper claim submission.
• Maintain SOPs and monitor 340B purchases across GPO, WAC, and 340B accounts.
• Coordinate with 340B affiliates, vendors, auditors, and internal departments.
• Perform spot audits and compliance assessments to verify data accuracy.

Skills

Auditing

340B compliance

Regulatory knowledge

Documentation

Contract pharmacy

Tools

Split-billing software

Job description

• 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.