Program Pharm Analyst Remote 340B
Job DescriptionAs a Pharmacy 340B Program Coordinator, you will audit, review and monitor utilization records and 340B purchasing accounts to ensure software and tools are working properly/accurately. To help achieve our mission, you will ensure that the 340B drug purchasing program is in compliance with all regulations and related interpretations. Ensuring program is fully implemented in all areas of qualified use while overseeing quality assurance and audits for 340B participating areas is of vital importance. Your ability to make certain that standard operating procedures are being followed while monitoring all drug purchases on the GPO, WAC and 340B accounts is essential. Serving as the Liaison for 340B software vendors and wholesale distributors is required. Taking ownership for maintaining a collaborative relationship with split billing software vendors/wholesalers and providing timely resolution and/or communication of any issues is expected.
- Provides expertise with the 340B Program to staff and participants regarding ongoing compliance.
- Develops and maintains internal relationships (i.e. accounting, legal, national) and external relationships (i,e, wholesalers, manufacturers, contract pharmacies, split-billing software vendors, employee benefit pharmacy benefits managers and third-party administrator vendors) as needed.
- Ensures that policies and procedures are developed, implemented and maintained according to organizational, regional, national, state and federal requirements/guidelines and are approved by the institution’s Legal department.
- Establishes consistent policies and procedures for 340B that ensure productivity and efficiency so that long-term management of the program does not hinder operations or create unnecessary costs.
- Maintains up to date policies and procedures on 340B purchasing processes.
- Develops systems and processes to limit program liabilities, provide proper audits to identify risk and prevent duplicate discounts/diversion.
- Reviews 340B Program policies and procedures on an ongoing basis and offers contributions and changes to ensure 340B compliance.
- Assists in the development, implementation and/or promotion of programmatic resources/tools to support staff.
- Regularly communicates with all staff involved with the 340B Program to be sure that processes remain efficient and to address any problems or suggestions for improvement.
- Routinely monitors industry publications and websites as well as professional media, literature and peers to ensure that the institution has the latest information regarding interpretations, rulings, suggestions and advanced ideas for improving participation.
- Ensures that the 340B Pharmacy Program is continuously compliant with 340B federal regulations.
- Conducts and/or coordinates an annual audit of all contract pharmacies. Documents results and follows-up on any findings.
- Assist in managing/troubleshooting Pharmacy billing issues while ensuring that adequate systems checks are reviewed to prevent billing issues.
- Evaluates patient eligibility for qualified and non-qualified patients in hospital based mixed use areas/clinics by reviewing patient medical records, insurance plans and hospital status.
- Monitors 340B compliance within workflow processes.
- Conducts monthly audits of all 340B eligible locations to verify adherence with the 340B Program guidelines and policies.
- 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.
- Ensures that audits follow current regulatory compliance recommendations and are completed at the facility level.
- Ensures evaluations of gaps at the site level and assists in providing the tools necessary to be compliant with the 340B Program.
- Evaluates covered entity compliance at the contract Pharmacy, covered entity and wholesaler levels.
- Performs 340B purchasing and utilization audits or compliance assessments internally as needed.
- Routinely audits all 340B programs to ensure compliance with regulations related to 340B purchasing.
- Performs monthly audits of contract Pharmacies.
- Performs monthly 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.
- Ensures that facilities maintain adherence to 340B Program regulations and guidelines.
- Develops and fosters working relationships with internal working counterparts (e.g. Information Technology, internal audit, results, accounting and others) 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.
- Assists in managing relationships, billing services and compliance with contracted 340B pharmacies.
- Assesses opportunities for cost savings and business improvements in 340B contract pharmacy utilization.
- Under the supervision on 340B Manager, assists the 340B contract pharmacy marketing program to attract and retain qualified retail pharmacy contracts and serve eligible patients.
- Under the supervision on 340B manager, analyzes the utilization of the program and existing software to identify ways to compliantly use the 340B Program to its fullest extent to meet the needs of underserved patients.
- Under the supervision of the 340B Manager, works with manufacturers as well as wholesalers to develop strategies for appropriate use of the program.
- Participates in projects, councils and special initiatives related to 340B, compliance, auditing functions, vendor selection and medication management.
- Develops a thorough understanding of the 340B Program and improves the overall efficiency, value and internal support of the 340B Program.
- Assesses opportunities for cost savings and system improvements to yield higher compliance.
- Builds knowledge of the healthcare and pharmacy services industry, use that knowledge to identify ways and make recommendations to improve the 340B Program.
- Evaluates and implements cost savings opportunities.
- Assists all customers to clarify requirements and propose sourcing options in addition to evaluating and recommending the best sourcing solution.
- Assists with developing routine reports that are a by-product of the inventory process and software allowing for concise information to be communicated to the leadership responsible for 340B inventory management.
- Ensures appropriate documentation and audit trails across areas of responsibility.
- 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 Oversight Council 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 while providing financial reports to hospitals or other covered entities relative to financial impact and liabilities.
- Performs covered entity-specific gross financial analysis and makes recommendations to improve program performance. Tracks financial impact over time, identifies root causes of adverse trends and makes recommendations to improve the program’s financial stability.
- Reviews and refines monthly 340B cost savings reports detailing purchasing and replacement practices as well as dispensing patterns.
- Monitors purchasing records for each 340B participant while clearly documenting utilization, savings, problem areas and exceptions or discrepancies. Relays results to pharmacy leadership and administration.
- Assists in monitoring for 340B pricing exclusions or shortages and establishes appropriate alternative products that are included when possible, including work with medical staff and formulary to ensure proper position and related use.
- Participates with the Prime Vendor and routinely reviews 340B formulary pricing, potential alternatives and possible additional savings as a result of GPO formulary.
- Manages and tracks 340B drug inventory including proper replenishment.
- Tracks, trends and reports 340B pharmaceutical sales and purchases data to ensure provider/physician and patient eligibility.
- Continuously monitors product minimum/maximum levels to effectively balance product availability and cost efficient inventory control.
- Maintains system databases to reflect changes in the drug formulary or product specifications.
- Ensures compliance with regulations related to 340B purchasing.
- May be required to work on inventory management of the 340B Program and offer input as to the application’s overall functionality and opportunities for improving compliance and or efficiency.
- Routinely monitors utilization records and 340B purchasing accounts to ensure that software or tools are working properly.
- Performs thorough quarterly reviews of the new 340B pricing list to search for and quickly address costly changes.
- Assists in overseeing 340B regulatory aspects of the inventory purchasing process for outpatient, inpatient and mixed use areas.
- Establishes a routine approach to updating the CDM/crosswalk for new products and product changes to ensure the accuracy of the utilization report and the efficiency/accuracy of the charge process.
- Maintains 340B split-billing software integrity and reviews applicable reports to identify areas for improvement.
- Assists in implementing new software packages and other changes in business practice based on changing regulations and policies.
- Assists 340B manager in maintenance and testing of tracking software.
- Integrates information from the pharmacy chargemaster system into the 340B split-billing computer system and incorporates that information into auditable and compliant processes.
- Works with outpatient pharmacy management and pharmacy informatics teams to ensure that the organization’s clinical information system is coordinated and integrated into the work with the 340B Program. This shall include the electronic interfaces between the electronic medical record, the virtual accumulator and any interfaces between the organization and contract pharmacy providers and/or administrators.
- Ensures split-billing software integrity and reviews applicable reports for areas of improvement.
- Periodically performs spot audits or compliance assessments in specific areas and specific products to ensure that the CDM is accurate, charges are coming across accurately and that utilization numbers are translating accurately into report for 340B reorders.
High School or GED
3 Years as a Pharmacy Tech
1-2 years 340B experience however highly preferred
Active VA Pharmacy Tech License
Familiarity with pharmacy computer systems, pharmacy automations and 340B split billing software systems. Familiar with pharmacy computer systems such as Epic, Cerner and Mckesson Meds manager, ICD-10 codes,Fluent with Microsoft Office.