Ambulatory Staff Pharmacist, 340B Audit and Compliance Coordinator

Kent Hospital•Warwick, RI

About The Position

Primary Function Provides integrated support to patients and physicians by providing a 'hands-on" approach to total quality patient care through the delivery of a full continuum of medication management services, to include preparing medications , the provision of pharmacological information, monitoring patient drug therapies and providing adherence support. Responsibilities Prepares and dispenses medications by reviewing and interpreting physician orders; detecting therapeutic incompatibilities; Provides thorough patient consultations on disease state management and medication therapies; Determines clinical appropriateness for immunizations; counsel and provide immunizations as indicated; Performs medication therapy management, including reviewing and monitoring of medication regimens, advising clinicians on evidence based therapy as indicated, documenting interventions; Completes pharmacy operational requirements by organizing and directing technicians' work flow; verifying their preparation and labeling of pharmaceuticals; verifying prescriptions; care coordination, identifying and resolving insurance related issues, recognizing situations where financial assistance can be applied. Understands and works in a manner to support 340B mission and compliance; possesses 340B knowledge sufficient to audit a claim and assist in the event of an external audit; conducts routine 340B contract pharmacy audits to ensure program compliance. Reviews third party payor sheets as necessary and makes updates to ensure 340B modifiers are transmitted when required. Oversees key 340B compliance functions, including report reviews, claim adjustments, pricing discrepancy resolution, and inappropriate accumulation monitoring. Manages ESP uploads for owned and contract pharmacies, maintains audit documentation, and update NDC/eligibility data to ensure program accuracy; Conducts monthly insurance and billing assessments, providing clarification for Medicare Part B, 340B requirements, and Managed Medicare billing; Supports internal and external 340B audits and utilize platforms such as Omnisys to ensure accurate billing workflows. Performs Beacon and Kalderos/Truzo claims data reporting and determines appropriate billing pathways (340B vs. MFP) based on insurance plan requirements. Participates in EPIC enhancements and updates 340B logic within EPIC to maintain compliance with evolving program rules Complies with state and federal drug laws as regulated by the state board of pharmacy, the drug enforcement administration, and local policies and procedures; maintaining records for controlled substances; removing outdated and damaged drugs from the pharmacy inventory; supervising the work results of support personnel; studying existing and new legislation; anticipating legislation; advising management on needed actions; Makes referrals to other health professionals as necessary; Develops own knowledge by participating in education programs; training pharmacy staff, students, interns, externs, residents, and health care professionals; Manages, organizes, and updates relevant data using database applications; Applies observations and recommendations to operational issues, increased productivity, quality, and customer-service standards; Identifies trends, resolves problems; recommends improvements; implements change; Actively participates in process improvement initiatives; Protects organization's value by keeping information confidential; Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations; Willing to do whatever is necessary for the betterment of the Company; Other duties as assigned

Requirements

Applicant must hold a Doctor of Pharmacy (PharmD) or BS in Pharmacy and be a licensed Pharmacist in the State of Rhode Island
Applicant must have 340B ACE certification or achieve 340B ACE within 6 months of hire
5+ years experience in a specialty or retail pharmacy setting

Nice To Haves

8+ years experience in a specialty or retail pharmacy setting
Applicant preferred to hold advanced certification (s) such as: Certified Specialty Pharmacist (CSP), immunization, medication therapy management, diabetic educator, cardiovascular educator

Responsibilities

Prepares and dispenses medications by reviewing and interpreting physician orders; detecting therapeutic incompatibilities
Provides thorough patient consultations on disease state management and medication therapies
Determines clinical appropriateness for immunizations; counsel and provide immunizations as indicated
Performs medication therapy management, including reviewing and monitoring of medication regimens, advising clinicians on evidence based therapy as indicated, documenting interventions
Completes pharmacy operational requirements by organizing and directing technicians' work flow; verifying their preparation and labeling of pharmaceuticals; verifying prescriptions; care coordination, identifying and resolving insurance related issues, recognizing situations where financial assistance can be applied
Understands and works in a manner to support 340B mission and compliance; possesses 340B knowledge sufficient to audit a claim and assist in the event of an external audit; conducts routine 340B contract pharmacy audits to ensure program compliance
Reviews third party payor sheets as necessary and makes updates to ensure 340B modifiers are transmitted when required
Oversees key 340B compliance functions, including report reviews, claim adjustments, pricing discrepancy resolution, and inappropriate accumulation monitoring
Manages ESP uploads for owned and contract pharmacies, maintains audit documentation, and update NDC/eligibility data to ensure program accuracy
Conducts monthly insurance and billing assessments, providing clarification for Medicare Part B, 340B requirements, and Managed Medicare billing
Supports internal and external 340B audits and utilize platforms such as Omnisys to ensure accurate billing workflows
Performs Beacon and Kalderos/Truzo claims data reporting and determines appropriate billing pathways (340B vs. MFP) based on insurance plan requirements
Participates in EPIC enhancements and updates 340B logic within EPIC to maintain compliance with evolving program rules
Complies with state and federal drug laws as regulated by the state board of pharmacy, the drug enforcement administration, and local policies and procedures; maintaining records for controlled substances; removing outdated and damaged drugs from the pharmacy inventory; supervising the work results of support personnel; studying existing and new legislation; anticipating legislation; advising management on needed actions
Makes referrals to other health professionals as necessary
Develops own knowledge by participating in education programs; training pharmacy staff, students, interns, externs, residents, and health care professionals
Manages, organizes, and updates relevant data using database applications
Applies observations and recommendations to operational issues, increased productivity, quality, and customer-service standards
Identifies trends, resolves problems; recommends improvements; implements change
Actively participates in process improvement initiatives
Protects organization's value by keeping information confidential
Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations
Willing to do whatever is necessary for the betterment of the Company
Other duties as assigned