Pharmacy 340B Program Analyst - York Hospital - Full-Time - Day

Schedule

Full-Time: 40 Hours/Weekly

7 to 3:30 but flexible M-F. No weekends or Holidays

General Summary

Performs a variety of duties to ensure that the organization remains compliant with the 340B Drug Pricing Program requirements. Performs regularly scheduled audits of contract pharmacies (if applicable) and 340B pharmacy operations to ensure compliance with 340B Program requirements for qualified patients, drugs and locations. Monitors and audits state Medicaid claims to ensure compliance to prevent potential duplicate discount rebates. Evaluates patient eligibility for qualified and non-qualified patients in mixed-use areas and clinics by reviewing patient medical records, insurance plans, and, if applicable, hospital status. Develops and maintains reports to monitor and improve 340B Program compliance and performance and for compliance and audit purposes. Maintains up-to-date policies and procedures on 340B purchasing processes. Provides proactive education to staff on policies and procedures related to inventory management and 340B procedures.

Essential Functions:

• Policy and Procedure Development • Maintains up-to-date policies and procedures on 340B purchasing processes. • Develops systems and processes to limit program liabilities and provide proper audits to identify risk and prevent duplicate discounts and diversion. • Reviews 340B Program policies and procedures on an ongoing basis and offer contributions and changes to ensure 340B compliance.
• Education • Develops proper 340B quality assurance training for employees as appropriate. • Provides proactive education to staff on policies and procedures related to inventory management and 340B procedures. • Expands professional development through related classes and seminars, current publications, and regional/national association membership participation.
• Audits • Perform audits on a scheduled basis; may involve presenting and resolving reconciliation issues as they arise during the monitoring and reconciliation process. • Performs monthly audits of contract pharmacies, if applicable and self-audits of 340B pharmacy operations. • Ensures compliance with 340B Program requirements for qualified patients, drugs, and locations. • Monitors and audits state Medicaid claims to ensure compliance to prevent potential duplicate discount rebates. • Uses Excel or a comparable data management program to filter out non-eligible transactions, including, but not limited to, drugs used to treat patients during inpatient care, Medicaid patients, drugs provided free by manufacturers, those provided at non-eligible locations, or prescriptions written by non-eligible providers. • Evaluates patient eligibility for qualified and non-qualified patients in mixed-use areas and clinics by reviewing patient medical records, insurance plans and, if applicable, hospital status. • Ensures that facilities maintain adherence to 340B Program regulations and guidelines. • Develops and fosters working relationships with internal working counterparts (e.g., IT, internal audit, accounting, etc.) to facilitate productive exchanges of information, to improve program efficiency and promote program compliance. Provides data, information and reports as needed for other business units within the organization.
• Program Enhancement/Optimization • Develops a thorough understanding of the 340B Program and improves its overall efficiency, value and internal support. • Assesses opportunities for cost savings and system improvements to yield higher compliance. Evaluates and implements cost savings opportunities. • Continues to build knowledge of the health care and pharmacy services industry. Uses that knowledge to identify ways and make recommendations to improve the 340B Program. • Provides assistance to all customers to clarify requirements and propose sourcing options. Evaluates and recommends the best sourcing solution.
• Reporting • Develops reports that can be used to educate staff and assist management in tracking the overall financial impact to the organization. Builds other reports, as appropriate, to monitor and improve 340B Program compliance and performance. • Maintains copies of reports for compliance and audit purposes. • Collaborates with the Pharmacy, Compliance and 340B governing board to develop monthly, quarterly and yearly audit metrics. • Constructs appropriate financial metrics to assess areas of improvement. • Develops and updates 340B Program reporting packages detailing volume, financial value and other reporting metrics as needed. • Uses provided tools to monitor prescription data, patient data, hospital data, payer data, site of care and, if required, ICD-10 codes. Summarizes and reports results to the appropriate individuals. • Monitors, reports, and analyzes contract pharmacy 340B activities. Provides financial reports to hospitals or othe