WVU Medicine
340B Audit-Compliance Analyst - Retail
WVU Medicine, Core, West Virginia, United States, 26529
340B Audit-Compliance Analyst - Retail
Join to apply for the 340B Audit-Compliance Analyst - Retail role at WVU Medicine.
Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position.
This position is responsible for assisting with the coordination of the 340B Drug Pricing Program for all qualified entities throughout the WVU Medicine Health System. The primary focus of this position is to review operating and regulatory compliance procedures and controls to ensure proper application of laws and requirements are met for continued eligibility for the 340B Program. Such review includes ongoing internal audit functions, data analysis, and operation review. Independent audits and appraisals are designed to assist the leadership of WVUHS to meet the 340B Drug Pricing Program goals of regulatory compliance, program effectiveness and program excellence.
Minimum Qualifications
Education, Certification, and/or Licensure:
High School Diploma or Equivalent.
Experience:
Three (3) years of healthcare, finance, or pharmacy experience.
Preferred Qualifications
Associate’s or Bachelor’s degree in Information Technology, Business Management, or Hospital Administration.
Nationally Certified Pharmacy Technician.
Apexus Advanced 340B Operations Certificate.
340B Drug Pricing Program experience.
Experience in data analysis, audit process and reporting.
Hospital or retail pharmacy experience.
Core Duties and Responsibilities
Develop systems and processes to limit program liabilities and provide proper audits to identify risk and prevent duplicate discounts and diversion.
Review and monitor utilization records and 340B purchasing accounts to ensure software or tools are working properly and accurately, performing audits or compliance assessments to validate processes.
Monitor monthly and annual reports on 340B Program participation which clearly documents utilization, savings, problem areas and exceptions or discrepancies.
Perform monthly compliance audits of contract pharmacies, hospital owned retail pharmacies, specialty pharmacies and hospital mixed use pharmacy to ensure that all 340B HRSA regulations are upheld.
Perform monthly compliance audits of patient eligibility, provider eligibility, and location eligibility.
Monitor purchasing records where 340B participation occurs, clearly documenting utilization, savings, problem areas and exceptions or discrepancies, to be shared with pharmacy leadership, Finance and Administration.
Maintain 340B Program software to ensure appropriate products are mapped to the appropriate charge code and in the correct ratio as well as maintain system when new charge codes are created.
Responsible for daily maintenance of the 340B Split Billing Software. Responsible for testing and validation of the 340B Split Billing Software and its communication with pharmacy software.
Monitor purchases for contract compliance, 340B compliance, and accurate pricing.
Assist WVUHS covered entities with reporting, data requests and other inquiries as necessary.
Responsible for uploading purchase data to 340B Split Billing Software on a monthly basis for all purchases made outside of the wholesaler.
Perform monthly audit to verify mapping is correct in the 340B Split Billing Software.
Provide purchaser(s) throughout the system with information and assistance needed to place orders using the appropriate accounts to maximize the 340B benefit.
Review product accumulation in split-billing software to ensure proper accumulations and identify negative trends.
Review ineligible claim data to ensure maximum benefit and identification of third‑party administrator claim processing issues.
Responsible for single‑dose vial reporting and monthly input of single‑dose vial waste into split‑billing software.
Responsible for updating any changes to charge code billing units from Epic into the split‑billing software for accuracy and consistency.
Create ad hoc reports to support program optimization and compliance.
Perform targeted audits, negative audits, referral process development and review suspect pending claims to find additional eligibility.
Complete accumulator reviews and targeted audits to ensure compliance.
Physical Requirements
While performing the duties of this position, the employee may be required to sit for long periods of time.
Extended periods of computer and telephone usage.
Must be able to move throughout the department work areas.
Working Environment
Standard office environment.
Skills and Abilities
Ability to handle and maintain confidential information.
Ability to work independently or cooperatively as a team member.
Ability to adapt to various workloads and assignments.
Must possess analytical and problem‑solving skills.
Must have effective verbal and written communication skills, as well as interpersonal skills necessary to communicate effectively with all levels of management.
Ability to interpret and analyze data.
Understanding basic computer programs and knowledge of MS Office applications including Word, PowerPoint, Excel and Outlook.
Additional Job Description Scheduled Weekly Hours:
40
Exempt/Non-Exempt:
Unspecified
Shift:
United States of America (Non‑Exempt)
Company:
SYSTEM West Virginia University Health System
Cost Center:
248 SYSTEM 340B Pharmacy Admin
#J-18808-Ljbffr
Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position.
This position is responsible for assisting with the coordination of the 340B Drug Pricing Program for all qualified entities throughout the WVU Medicine Health System. The primary focus of this position is to review operating and regulatory compliance procedures and controls to ensure proper application of laws and requirements are met for continued eligibility for the 340B Program. Such review includes ongoing internal audit functions, data analysis, and operation review. Independent audits and appraisals are designed to assist the leadership of WVUHS to meet the 340B Drug Pricing Program goals of regulatory compliance, program effectiveness and program excellence.
Minimum Qualifications
Education, Certification, and/or Licensure:
High School Diploma or Equivalent.
Experience:
Three (3) years of healthcare, finance, or pharmacy experience.
Preferred Qualifications
Associate’s or Bachelor’s degree in Information Technology, Business Management, or Hospital Administration.
Nationally Certified Pharmacy Technician.
Apexus Advanced 340B Operations Certificate.
340B Drug Pricing Program experience.
Experience in data analysis, audit process and reporting.
Hospital or retail pharmacy experience.
Core Duties and Responsibilities
Develop systems and processes to limit program liabilities and provide proper audits to identify risk and prevent duplicate discounts and diversion.
Review and monitor utilization records and 340B purchasing accounts to ensure software or tools are working properly and accurately, performing audits or compliance assessments to validate processes.
Monitor monthly and annual reports on 340B Program participation which clearly documents utilization, savings, problem areas and exceptions or discrepancies.
Perform monthly compliance audits of contract pharmacies, hospital owned retail pharmacies, specialty pharmacies and hospital mixed use pharmacy to ensure that all 340B HRSA regulations are upheld.
Perform monthly compliance audits of patient eligibility, provider eligibility, and location eligibility.
Monitor purchasing records where 340B participation occurs, clearly documenting utilization, savings, problem areas and exceptions or discrepancies, to be shared with pharmacy leadership, Finance and Administration.
Maintain 340B Program software to ensure appropriate products are mapped to the appropriate charge code and in the correct ratio as well as maintain system when new charge codes are created.
Responsible for daily maintenance of the 340B Split Billing Software. Responsible for testing and validation of the 340B Split Billing Software and its communication with pharmacy software.
Monitor purchases for contract compliance, 340B compliance, and accurate pricing.
Assist WVUHS covered entities with reporting, data requests and other inquiries as necessary.
Responsible for uploading purchase data to 340B Split Billing Software on a monthly basis for all purchases made outside of the wholesaler.
Perform monthly audit to verify mapping is correct in the 340B Split Billing Software.
Provide purchaser(s) throughout the system with information and assistance needed to place orders using the appropriate accounts to maximize the 340B benefit.
Review product accumulation in split-billing software to ensure proper accumulations and identify negative trends.
Review ineligible claim data to ensure maximum benefit and identification of third‑party administrator claim processing issues.
Responsible for single‑dose vial reporting and monthly input of single‑dose vial waste into split‑billing software.
Responsible for updating any changes to charge code billing units from Epic into the split‑billing software for accuracy and consistency.
Create ad hoc reports to support program optimization and compliance.
Perform targeted audits, negative audits, referral process development and review suspect pending claims to find additional eligibility.
Complete accumulator reviews and targeted audits to ensure compliance.
Physical Requirements
While performing the duties of this position, the employee may be required to sit for long periods of time.
Extended periods of computer and telephone usage.
Must be able to move throughout the department work areas.
Working Environment
Standard office environment.
Skills and Abilities
Ability to handle and maintain confidential information.
Ability to work independently or cooperatively as a team member.
Ability to adapt to various workloads and assignments.
Must possess analytical and problem‑solving skills.
Must have effective verbal and written communication skills, as well as interpersonal skills necessary to communicate effectively with all levels of management.
Ability to interpret and analyze data.
Understanding basic computer programs and knowledge of MS Office applications including Word, PowerPoint, Excel and Outlook.
Additional Job Description Scheduled Weekly Hours:
40
Exempt/Non-Exempt:
Unspecified
Shift:
United States of America (Non‑Exempt)
Company:
SYSTEM West Virginia University Health System
Cost Center:
248 SYSTEM 340B Pharmacy Admin
#J-18808-Ljbffr