340B Audit & Compliance Analyst - Mixed-Use/Hospital Pharmacy

WVU Medicine-posted 3 months ago
Full-time
5,001-10,000 employees
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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.

  • Develops systems and processes to limit program liabilities and provides proper audits to identify risk and prevent duplicate discounts and diversion.
  • Reviews and monitors utilization records and 340B purchasing accounts to ensure software or tools are working properly and accurately, performing audits or compliance assessments to validate processes.
  • Monitors monthly and annual reports on 340B Program participation which clearly documents utilization, savings, problem areas and exceptions or discrepancies.
  • Performs 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.
  • Performs monthly compliance audits of patient eligibility, provider eligibility, and location eligibility.
  • Monitors and audits state Medicaid claims to ensure compliance and or event potential duplicate discounts.
  • Monitors 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.
  • Maintains 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 the testing and validation of the 340B Split Billing Software and its communication with the pharmacy software.
  • Monitors purchases for contract compliance, 340B compliance, and accurate pricing.
  • Assists WVUHS covered entities with reporting, data requests and other inquiries as necessary.
  • Responsible for uploading purchase data to the 340B Split Billing Software on a monthly basis for all purchases made outside of the wholesaler.
  • Performs monthly audit to verify mapping is correct in the 340B Split Billing Software.
  • Provides purchaser(s) throughout the system with information and assistance needed to place orders using the appropriate accounts to maximize the 340B benefit.
  • Reviews product accumulation in split-billing software to ensure proper accumulations and identify negative trends.
  • Reviews ineligible claim data to ensure maximum benefit and identification of third party administrator claim processing issues.
  • Active member of the 340B Work/Affinity meetings and all system buyers meetings.
  • 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.
  • Provides Penny Buys report to purchasers on a monthly basis.
  • Performs targeted audits, negative audits, referral process development and reviews suspect pending claims to find additional eligibility.
  • Completes accumulator reviews and targeted audits to ensure compliance.
  • Associate degree in Information Technology, Business Management, or Hospital Administration; OR Nationally Certified Pharmacy Technician OR High School Diploma or equivalent AND Two (2) years of experience in a healthcare related field.
  • Three (3) years of healthcare, finance, or pharmacy experience.
  • Bachelor degree in Information Technology, Business Management, or Hospital Administration or Nationally Certified Pharmacy Technician.
  • Nationally Certified by the Pharmacy Technician Certification Board with 2 years of experience.
  • Apexus Advanced Operations Certificate preferred upon hire.
  • 340B Drug Pricing Program experience.
  • Experience in data analysis, audit process and reporting.
  • Hospital or retail pharmacy experience.
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