Pharmacy 340B Program Manager Internal Only

Ellis Medicine•Schenectady, NY

About The Position

SECTION I: BASIC FUNCTION: Ellis Medicine has expanded the 340B Drug Pricing Program in many areas. The Pharmacy 340B Program Manager will develop, lead and oversee the 340B program for Ellis Medicine. SECTION II: EDUCATION AND EXPERIENCE REQUIREMENT(S): Baccalaureate Degree preferred; experience with DSH/ 340B program preferred Pharmacy Operations or Pharmacy purchasing experience preferred Accounting or Business background would be an advantage Experience in Auditing and Review preferred Computer skills must include data aggregation and the integration of the data; and extensive knowledge of database software such as excel and access. Experience with split billing software helpful. Demonstrated self-starter and team player, able to work independently SECTION III: MAKING ELLIS EXCEPTIONAL (MEE) BEHAVIORS & STANDARDS SECTION IV: PRIMARY RESPONSIBILITIES OF THE POSITION: Serves as primary internal and external program coordinator and liaison for all 340B-related matters. Serves as the institutional “compliance expert or authority” on 340B regarding program details, policies, and procedures of the virtual inventory processes required for mixed-use areas. Serves as primary liaison to key stakeholders to help ensure appropriate utilization of the 340B program and compliance with all program requirements. Will establish, help lead and assist the organization’s 340B oversight team, which will include representation from pharmacy, legal, compliance, finance, and senior administration. Provides expertise with the 340B program to staff and participants regarding ongoing compliance. Develops and manages internal relationships (accounting, legal, national) and external relationships and contracts (wholesalers, manufacturers, contract pharmacies, split-billing software vendors, employee benefit pharmacy benefits managers (PBMs), and third-party administrator (TPA) vendors) as needed. Develops business plans to prioritize and implement programs related to program services and contract pharmacy agreements. Ensures that policies and procedures are developed and implemented according to organizational, regional, national, state, and federal requirements and guidelines and are approved by the institution’s legal department. Develops and manages health system education, training, awareness and customer service training for all 340B covered entities. Oversees the 340B contract pharmacy marketing program to attract and retain qualified retail pharmacy contracts and serve eligible patients. Tracks, reports and communicates program savings on a regular basis. Develops, executes, and documents self-audits of the 340B process. Coordinates and ensures remediation of findings. Conducts and/or coordinates periodic audits of all contract pharmacies. Document results and follow-up on any findings. Monitors and assesses 340B guidance and or rule changes. Reviews and monitors all points of service where 340B participation occurs to ensure policy and procedure compliance, covered entity eligibility, and “covered patient” eligibility. Responsible for managing and troubleshooting pharmacy billing issues and ensuring that adequate systems checks are reviewed to prevent billing issues. Monitors utilization records and 340B purchasing accounts to ensure that software or tools are working properly and accurately, performing audits or compliance assessments internally as needed; coordinates external compliance assessments with outside firms, where appropriate, to validate internal processes. Evaluates patient eligibility for qualified and non-qualified patients in hospital-based mixed-use areas and clinics by reviewing patient medical records, insurance plans, and hospital status Establishes a routine approach to updating the CDM/crosswalk for new products and product changes to ensure both the accuracy of the utilization report and the efficiency and accuracy of the charge process. Maintains 340B split-billing software integrity and reviews applicable reports to identify areas for improvement. Assists in implementing new software packages and other changes in business practice based on changing regulations and policies. Is responsible for maintenance and testing of tracking software. Assists with oversight of contracts and business development in collaboration with the Director of Pharmacy to leverage and maximize purchasing power in order to realize maximum cost savings to the institution.

Requirements

Computer skills must include data aggregation and the integration of the data; and extensive knowledge of database software such as excel and access.
Demonstrated self-starter and team player, able to work independently

Nice To Haves

Baccalaureate Degree preferred
experience with DSH/ 340B program preferred
Pharmacy Operations or Pharmacy purchasing experience preferred
Accounting or Business background would be an advantage
Experience in Auditing and Review preferred
Experience with split billing software helpful.

Responsibilities

Serves as primary internal and external program coordinator and liaison for all 340B-related matters.
Serves as the institutional “compliance expert or authority” on 340B regarding program details, policies, and procedures of the virtual inventory processes required for mixed-use areas.
Serves as primary liaison to key stakeholders to help ensure appropriate utilization of the 340B program and compliance with all program requirements.
Will establish, help lead and assist the organization’s 340B oversight team, which will include representation from pharmacy, legal, compliance, finance, and senior administration.
Provides expertise with the 340B program to staff and participants regarding ongoing compliance.
Develops and manages internal relationships (accounting, legal, national) and external relationships and contracts (wholesalers, manufacturers, contract pharmacies, split-billing software vendors, employee benefit pharmacy benefits managers (PBMs), and third-party administrator (TPA) vendors) as needed.
Develops business plans to prioritize and implement programs related to program services and contract pharmacy agreements.
Ensures that policies and procedures are developed and implemented according to organizational, regional, national, state, and federal requirements and guidelines and are approved by the institution’s legal department.
Develops and manages health system education, training, awareness and customer service training for all 340B covered entities.
Oversees the 340B contract pharmacy marketing program to attract and retain qualified retail pharmacy contracts and serve eligible patients.
Tracks, reports and communicates program savings on a regular basis.
Develops, executes, and documents self-audits of the 340B process.
Coordinates and ensures remediation of findings.
Conducts and/or coordinates periodic audits of all contract pharmacies.
Document results and follow-up on any findings.
Monitors and assesses 340B guidance and or rule changes.
Reviews and monitors all points of service where 340B participation occurs to ensure policy and procedure compliance, covered entity eligibility, and “covered patient” eligibility.
Responsible for managing and troubleshooting pharmacy billing issues and ensuring that adequate systems checks are reviewed to prevent billing issues.
Monitors utilization records and 340B purchasing accounts to ensure that software or tools are working properly and accurately, performing audits or compliance assessments internally as needed; coordinates external compliance assessments with outside firms, where appropriate, to validate internal processes.
Evaluates patient eligibility for qualified and non-qualified patients in hospital-based mixed-use areas and clinics by reviewing patient medical records, insurance plans, and hospital status
Establishes a routine approach to updating the CDM/crosswalk for new products and product changes to ensure both the accuracy of the utilization report and the efficiency and accuracy of the charge process.
Maintains 340B split-billing software integrity and reviews applicable reports to identify areas for improvement.
Assists in implementing new software packages and other changes in business practice based on changing regulations and policies.
Is responsible for maintenance and testing of tracking software.
Assists with oversight of contracts and business development in collaboration with the Director of Pharmacy to leverage and maximize purchasing power in order to realize maximum cost savings to the institution.