Ambulatory Staff Pharmacist, 340B Audit and Compliance Coordinator

Primary Function

Provides integrated support to patients and physicians by providing a 'hands-on" approach to total quality patient care through the delivery of a full continuum of medication management services, to include preparing medications , the provision of pharmacological information, monitoring patient drug therapies and providing adherence support.

Responsibilities

• Prepares and dispenses medications by reviewing and interpreting physician orders; detecting therapeutic incompatibilities;
• Provides thorough patient consultations on disease state management and medication therapies;
• Determines clinical appropriateness for immunizations; counsel and provide immunizations as indicated;
• Performs medication therapy management, including reviewing and monitoring of medication regimens, advising clinicians on evidence based therapy as indicated, documenting interventions;
• Completes pharmacy operational requirements by organizing and directing technicians' work flow; verifying their preparation and labeling of pharmaceuticals; verifying prescriptions; care coordination, identifying and resolving insurance related issues, recognizing situations where financial assistance can be applied.
• Understands and works in a manner to support 340B mission and compliance; possesses 340B knowledge sufficient to audit a claim and assist in the event of an external audit; conducts routine 340B contract pharmacy audits to ensure program compliance.
• Reviews third party payor sheets as necessary and makes updates to ensure 340B modifiers are transmitted when required.
• Oversees key 340B compliance functions, including report reviews, claim adjustments, pricing discrepancy resolution, and inappropriate accumulation monitoring.
• Manages ESP uploads for owned and contract pharmacies, maintains audit documentation, and update NDC/eligibility data to ensure program accuracy;
• Conducts monthly insurance and billing assessments, providing clarification for Medicare Part B, 340B requirements, and Managed Medicare billing;
• Supports internal and external 340B audits and utilize platforms such as Omnisys to ensure accurate billing workflows.
• Performs Beacon and Kalderos/Truzo claims data reporting and determines appropriate billing pathways (340B vs. MFP) based on insurance plan requirements.
• Participates in EPIC enhancements and updates 340B logic within EPIC to maintain compliance with evolving program rules
• Complies with state and federal drug laws as regulated by the state board of pharmacy, the drug enforcement administration, and local policies and procedures; maintaining records for controlled substances; removing outdated and damaged drugs from the pharmacy inventory; supervising the work results of support personnel; studying existing and new legislation; anticipating legislation; advising management on needed actions;
• Makes referrals to other health professionals as necessary;
• Develops own knowledge by participating in education programs; training pharmacy staff, students, interns, externs, residents, and health care professionals;
• Manages, organizes, and updates relevant data using database appli