340B Pharmacy Compliance Specialist

JOB SUMMARY

This position is responsible for ensuring program compliance for TJ Regional Health Pharmacy Services within the 340B Drug Pricing Program and controlled substances diversion monitoring. Individual will work collaboratively with the Director of Pharmacy, 340B Coordinator, and other stakeholders to lead comprehensive audits and internal controls for 340B and controlled substances diversion monitoring, as well as support Departmental revenue cycle and other key initiatives.

Job Requirements

JOB REQUIREMENTS

Minimum Education

•  High school diploma or equivalent required.
•  BS or BA degree from an accredited college or 3-5 years of relevant experience in related healthcare field/Pharmacy desirable.

Minimum Work Experience

•  Experience with the 340B program and its compliance requirements preferred.
•  Experience with billing/coding, auditing, or health care compliance preferred.
•  Knowledge of health care and/or pharmacy operations preferred.

Required Skills

Interpersonal Skills:

•  Ability to maintain inter- and intradepartmental relations. Accuracy in following directions. Willingness to work under indirect supervision.

Essential Technical/Motor Skills:

•  Proficiency in Microsoft Office software, such as: Word, Excel required
•  Proficiency in 340B split billing software
•  Ability to navigate patient health records

Requires constant mental concentration to details and frequently cope with deadlines. Must be able to read, write and communicate in an effective manner. Analytical skills to sort medications and pharmaceutical supplies, make minor calculation, maintain records and inventories, measure and comprehend medical technology and terminology.

FUNCTIONAL DEMANDS

Physical Requirements

Sitting - 16-31%

Walking - 16-31%

Standing - 16-31%

Bending/Squatting - 1-15%

Climbing/Kneeling - 1-15%

Twisting - 16-31%

 

Visual and Hearing Requirements

Must be able to see with corrective eye wear.

Must be able to hear clearly with assistance.

 

Physical/Environmental Demands

Lifting - 0-50 lbs, 50 or more with assistance

Carrying - 0-50 lbs, 50 or more with assistance

Pulling - Up to 100 lbs

Pushing - Up to 100 lbs

 

OSHA Category

Minimal potential for direct exposure

 

ESSENTIAL FUNCTIONS

340B Program Compliance (75%)

1. Develop and foster working relationships with internal working counterparts (IT, internal audit, results, accounting, and others) to facilitate productive exchanges of information to improve program efficiency and promote program compliance. Provide data, information, and reports as needed for other business units within the organization.
2. Be involved in any and all 340B audits.
3. Monitor and audit state Medicaid claims to ensure compliance to prevent potential duplicate discount rebates.
4. Using Excel or a comparable data management program, 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.
5. Evaluate patient eligibility for qualified and non-qualified patients in mixed-use areas and clinics by reviewing patient medical records, insurance plans, and hospital status.
6. Ensure that facilities maintain adherence to 340B Program regulations and guidelines.
7. Perform audits on a scheduled basis; may involve presenting and resolving reconciliation issues as they arise during the monitoring and reconciliation process.
8. Perform monthly audits of contract pharmacies.
9. Perform monthly self-audits of 340B pharmacy operations.
10. Ensure compliance with 340B Program requirements for qualified patients, drugs, and locations.
11. Reviews and monitors all points of service where 340B participation occurs to ensure policy and procedure compliance, covered entity eligibility, and “covered patient” eligibility.
12. Responsible for managing and troubleshooting pharmacy billing issues and ensuring that adequate systems checks are reviewed to prevent billing issues.
13. Monitors 340B compliance within workflow processes.
14. Ensures compliance with all aspects of the 340B Program and implements all applicable aspects of HRSA’s Office of Pharmacy Affairs guidance, as well as organizational policies and procedures.
15. Evaluates covered entity compliance at the contr