Salinas Valley Health-posted about 1 month ago
$38 - $48/Yr
Full-time • Entry Level
Salinas, CA
1,001-5,000 employees

The 340B Program Auditor is responsible for conducting comprehensive audits of 340B prescription claims, verifying patient eligibility, prescriber-location relationships, and ensuring site compliance to maintain the hospital's eligibility and prevent diversion in the 340B Drug Pricing Program. This role supports both in-house and contract pharmacy auditing, provides documentation for HRSA audit readiness, and ensures adherence to federal program requirements.

  • Review accumulations and dispensing events from third party administrator (TPA) and contract pharmacy management systems
  • Validate prescriber-patient-location relationships for each claim to ensure compliance
  • Identify and document exceptions or potential diversion risks
  • Perform monthly compliance audits of contract pharmacies, hospital-owned retail pharmacies, specialty pharmacies, and hospital mixed-use pharmacy operations
  • Monitor and audit state Medicaid claims to ensure compliance and prevent duplicate discounts
  • Perform monthly compliance audits of patient eligibility criteria
  • Verify provider eligibility and location eligibility requirements
  • Review utilization records and 340B purchasing accounts to ensure software tools are working properly and accurately
  • Conduct targeted audits and negative audits to identify additional eligibility opportunities
  • Maintain 340B Program software to ensure appropriate products are mapped to correct charge codes and ratios
  • Perform daily maintenance of 340B Split Billing Software
  • Upload purchase data to 340B Split Billing Software monthly for all purchases made outside of wholesaler
  • Conduct monthly audits to verify mapping accuracy in 340B Split Billing Software
  • Update charge code billing units from EHR into split-billing software for accuracy and consistency
  • Prepare and maintain comprehensive audit logs and exception reports
  • Support HRSA audit responses and internal compliance reviews
  • Ensure data traceability and documentation readiness for regulatory requirements
  • Monitor monthly and annual reports on 340B Program participation documenting utilization, savings, problem areas, and exceptions
  • Monitor purchases for contract compliance, 340B compliance, and accurate pricing
  • Review product accumulation in split-billing software to ensure proper accumulations and identify negative trends
  • Analyze purchasing records where 340B participation occurs, documenting utilization, savings, and discrepancies
  • Provide purchasers with information and assistance for placing orders using appropriate accounts to maximize 340B benefit
  • Performs other duties as assigned.
  • High school diploma or equivalent required.
  • Apexus 340B University Certificate required within 90 days of hire.
  • California Pharmacy Technician license required.
  • One (1) year of healthcare auditing, pharmacy technician, or compliance experience required.
  • Bachelor’s degree in Information Technology, Business Management, or Hospital Administration preferred.
  • Apexus Advanced Operations Certificate preferred.
  • Nationally Certified by the Pharmacy Technician Certification Board preferred.
  • 340B Drug Pricing Program experience preferred.
  • Experience in data analysis, audit process, reporting and hospital or retail pharmacy experience preferred.
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