| This hands-on position will be responsible for managing 340B related functions of the organization. The role requires the individual to support the organization through internal and/or HRSA/OPA, manufacturer, 3rd party insurance audits. Requires extensive review of data collection and analysis to detect deficient controls, and to optimize compliance with 340B regulations, and policies and procedures. This individual must be a self-starter and capable of planning and performing longitudinal operational, financial, and compliance audits of moderate difficulty and complexity with minimum supervision. This individual will also work with the pharmacy and other stakeholders to ensure that the organization meets all 340B requirements. The position reports directly to the CEO, and is a member of Senior Management Staff. Duties and Responsibilities • Provides vigilant oversight of the organizations’ 340B program through internal audit functions that address controls of the 340B drug program. • Provides guidance and oversight on the day-to-day operation of the 340B program including, but not limited to, 340B purchasing, contracting, pricing, billing, system maintenance and inventory management. • Performs business process walkthroughs, inquiries, claims, and documentation reviews to assess whether procedures and internal controls exist to comply with the 340B program requirements. • Monitors vendor software and contract pharmacy replenishments to ensure that the 340B drugs are utilized in a compliant and consistent manner with scrutiny for diversion and duplicate discounts through the routine auditing of transactions. • Reviews contract pharmacy claims for all registered contract pharmacies of the covered entity and provides detailed reports of audits to the 340B oversight team. • Reviews 340B Office of Pharmacy Affairs Information Systems (340B OPAIS) database monthly to ensure database entries are complete, accurate, and auditable. • Assesses the definitions of an eligible provider specific to the covered entity and reviews physicians, nurse practitioners, residents, physician assistants, and medical residents who write 340B prescriptions. • Prepares detailed reports on audit findings on a routine basis and conveys information regarding audit results effectively to the 340B oversight team regularly. • Accountable to oversee inventory control related to 340B at all qualified pharmacy sites. • Stays informed and up to date of the ever-changing 340B regulations and guidelines.• Reviews all claims from all 340B registered ID and all contract pharmacies to ensure all claims are valid, accuratge, and accounted for. • Works with PBM and TPA to resolve issues, reverse claims, to resolve credit/rebill issues, and ensure all necessary identifier codes are utilized. • Works with CFO and COOs to ensure all needed documentation is occurring and present for each claim in the E.H.R., CAREWare and case management notes. • Works with outside providers and referral agencies and physicians to ensure compliance documentation is received. • Maintains the Policy and Procedure manual for 340B business operations. Addresses any changes to those policies with CEO and ensures policies and procedures are followed. • Ensures auditable records are available at all times. • Engage and participate in all 340B regulatory calls, webinars and trainings. • Particiapte in all 340B conferences and trainings. Successfully complete all trainings offered by the primevendor APEXUS. • Assists in developing and ensures compliance with training materials, resources and workflows. • Attend and actively participate in all legislative activity, political information and education surrounding the importance of 340B. • Performs all other duties as assigned. Qualification and Requirements: • A BS/BA degree is required, preferably in accounting, pharmacy management, or business administration. • A minimum of two (2) years of internal auditing, pharmacy operations, and/or public accounting experience is desired. • Experience with analyzing and reporting data to identify issues, trends, or exceptions. • Experience with organizing and managing multiple priorities, including demonstrable experience in workflow management systems and/or service delivery. • Good oral and written communications, including familiarity with Microsoft Office (Word, Excel, PowerPoint) and healthcare software systems. • Requires knowledge of online technology and healthcare IT systems. • Strong knowledge of Ryan White and STD Section 318 grants and the Federal 340B Drug Program is desirable. • Understanding of contract pharmacy software systems is a plus. Note: This job description is not intended to be all-inclusive; an employee also will perform other reasonably related job responsibilities as assigned by immediate supervisor and other management as required. This organization reserves the right to revise or change job duties as the need arises. This job description does not constitute a written or implied contract of employment. EOE/ADA |
