Enterprise 340B Audit & Compliance Analyst

WVU Medicine•Home Work - OH (Remote), OH

About The Position

This position assists with coordinating the 340B Drug Pricing Program for qualified entities throughout the WVU Medicine Health System. Its primary focus is reviewing operating and regulatory compliance procedures and controls to ensure laws and requirements are properly applied and continued program eligibility is maintained. The work includes ongoing internal audits, data analysis, and operational reviews. Independent audits and appraisals support WVU Health System leadership in achieving regulatory compliance, program effectiveness, and program excellence.

Requirements

High school diploma or equivalent.
Three years of healthcare, finance, or pharmacy experience.
Ability to handle and maintain confidential information.
Ability to work independently or cooperatively as a team member.
Ability to adapt to varying workloads and assignments.
Analytical and problem-solving skills.
Effective verbal and written communication and interpersonal skills to communicate with all levels of management.
Ability to interpret and analyze data.
Understanding of basic computer programs and knowledge of Microsoft Office applications, including Word, PowerPoint, Excel, and Outlook.

Nice To Haves

Associate’s or bachelor’s degree in Information Technology, Business Management, or Hospital Administration.
Nationally Certified Pharmacy Technician credential.
Apexus Advanced 340B Operations Certificate.
Experience with the 340B Drug Pricing Program.
Experience in data analysis, audit processes, and reporting.
Hospital or retail pharmacy experience.

Responsibilities

Develop systems and processes to limit program liabilities and conduct audits to identify risk and prevent duplicate discounts and diversion.
Review and monitor utilization records and 340B purchasing accounts; validate software and tools through audits or compliance assessments.
Monitor monthly and annual reports on program participation, documenting utilization, savings, problem areas, exceptions, and discrepancies.
Perform monthly compliance audits of contract pharmacies, hospital-owned retail pharmacies, specialty pharmacies, and hospital mixed-use pharmacies.
Perform monthly audits of patient, provider, and location eligibility.
Monitor purchasing records involving 340B participation and document utilization, savings, problem areas, exceptions, and discrepancies for pharmacy leadership, Finance, and Administration.
Maintain 340B Program software, including product-to-charge-code mapping, ratios, and updates when new charge codes are created.
Maintain, test, and validate the 340B Split Billing Software and its communication with pharmacy software.
Monitor purchases for contract compliance, 340B compliance, and accurate pricing.
Assist covered entities with reporting, data requests, and other inquiries.
Upload monthly purchase data to the 340B Split Billing Software for purchases made outside the wholesaler.
Perform monthly audits to verify mapping in the 340B Split Billing Software.
Provide system purchasers with information and assistance to place orders using appropriate accounts and maximize the 340B benefit.
Review product accumulation in split-billing software to confirm proper accumulation and identify negative trends.
Review ineligible claim data to maximize benefit and identify third-party administrator claim-processing issues.
Complete single-dose-vial reporting and enter single-dose-vial waste into split-billing software monthly.
Update charge-code billing-unit changes from Epic in split-billing software for accuracy and consistency.
Create ad hoc reports to support program optimization and compliance.
Perform targeted and negative audits, develop referral processes, and review suspect pending claims to identify additional eligibility.
Complete accumulator reviews and targeted audits to ensure compliance.