Pharmacy Business Analyst

Business Overview:

As the first and largest specialty pharmacy integrator and accelerator, Shields Health Solutions (SHS) is the industry leader in providing innovative and comprehensive care for the nation's chronically ill patient population. Shields creates and manages hospital-owned specialty pharmacy programs for hospitals and health systems who want to offer coordinated care services for patients with chronic illnesses. Using an integrated approach to patient care through our purpose-built software platform, TelemetryRx, our Patient Liaison model, and our centralized clinical support team, Shields is redefining what it means to provide superior, fully-integrated patient care from clinic to pharmacy to patient's homes. Our innovative model and proven results in such a unique industry have led us to be one of the fastest growing healthcare companies in the nation with an immense impact on patients' lives.

 

Position Overview:

Shields Health Solutions is looking to hire a 340B Pharmacy Business Analyst, reporting to the regional Directors of 340B, to work directly with pharmacy compliance, finance, and operations individuals at its health system partners.  The Pharmacy Business Analyst’s primary responsibility is to ensure pharmacy program compliance and generate additional 340B savings in order to service a greater volume of the most vulnerable patient populations. The 340B team is responsible for building and supporting a compliant 340B program for each of its clients while simultaneously identifying opportunities for enhanced 340B savings. They will be tasked with developing new 340B strategies to implement, design policies and procedures aligned with 340B best practices, and work directly with regional operations teams to track the value of the 340B Program to SHS health system partners. Each SHS client heavily relies on the 340B Program to keep its doors open and continue to provide the highest level of care to their patients. They will interact and be a key resource for leaders across the business as we unlock value for the Company and our customers. 

Job Responsibilities and Duties:

• Develop a thorough understanding of the 340B program, monitor recent legislative changes or proposed 340B pharmacy regulations, and communicate current 340B trends and interpretations directly affecting SHS health system partners
• Work directly with health system 340B Compliance/Operations teams to monitor 340B Program compliance, audit non-340B prescriptions, identify new margin enhancement opportunities, and implement new 340B expansion strategies
• Develop an innate knowledge of all SHS partner pharmacy dispensing systems, EMRs, as well as various 340B platforms to monitor 340B activity
• Review Hospital Medicare Cost Reports and identify 340B eligible departments for new partner opportunities
• Track 340B Program savings generated by SHS health system partners
• Assist in implementing new 340B Third-Party Administrator (TPA) platforms for new hospital clients
• Develop and/or update 340B policies and procedures utilized by SHS partners to reflect 340B Program best practices and ensure partner 340B Program qualifications are met and maintained
• Assess and analyze each customers’ wholesaler accounts to ensure appropriate pricing is reflected for all medications
• Review each customer’s wholesaler catalog to confirm access to Limited Distribution Drugs (LDD) at all price points (340B & Non-340B)
• Ability to track LDD products dispensed as well as on-hand inventory levels in order to develop required reports by select PhRMA manufacturers
• Monitor 340B pricing restrictions issued by manufacturers and communicate SHS partner impact/SHS contribution profit
• Develop strategies in collaboration with SHS partners to consistently update eligible provider listings and data extracts utilized to identify 340B prescriptions
• Manage and track partner pharmacy activity dispensed through contract pharmacy arrangements. Create monthly reports to identify 340B revenue, dispensing fees, and corresponding COGS dispensed via contract pharmacy
• Maintain knowledge of pharmacy billing requirements for each State Medicaid agency
• Create daily reports to identify 340B eligible Managed Medicaid prescriptions and ensure appropriate 340B modifiers are included at the claim level to mitigate the risk of duplicate discounts
• Develop monthly reports and reprocess Medicaid Fee-for-Service prescriptions to reflect required acquisition cost reimbursement
• Perform weekly audits of non-340b prescriptions dispensed by partner pharmacy locations and gather 340B supporting documentation from the EMR to identify 340B optimization opportunities
• Collaborate with 340B Compliance team