Schedule:
Full Time
40-hours per week
Monday - Friday 7am to 3:30pm

General Summary

Performs a variety of duties to ensure that the organization remains compliant with the 340B Drug Pricing Program requirements. Performs regularly scheduled audits of contract pharmacies (if applicable) and 340B pharmacy operations to ensure compliance with 340B Program requirements for qualified patients, drugs and locations. Monitors and audits state Medicaid claims to ensure compliance to prevent potential duplicate discount rebates. Evaluates patient eligibility for qualified and non-qualified patients in mixed-use areas and clinics by reviewing patient medical records, insurance plans, and, if applicable, hospital status. Develops and maintains reports to monitor and improve 340B Program compliance and performance and for compliance and audit purposes. Maintains up-to-date policies and procedures on 340B purchasing processes. Provides proactive education to staff on policies and procedures related to inventory management and 340B procedures.

Essential Functions:

Policy and Procedure Development - Maintains up-to-date policies and procedures on 340B purchasing processes. - Develops systems and processes to limit program liabilities and provide proper audits to identify risk and prevent duplicate discounts and diversion. - Reviews 340B Program policies and procedures on an ongoing basis and offer contributions and changes to ensure 340B compliance. Education - Develops proper 340B quality assurance training for employees as appropriate. - Provides proactive education to staff on policies and procedures related to inventory management and 340B procedures. - Expands professional development through related classes and seminars, current publications, and regional/national association membership participation. Audits - Perform audits on a scheduled basis; may involve presenting and resolving reconciliation issues as they arise during the monitoring and reconciliation process. - Performs monthly audits of contract pharmacies, if applicable and self-audits of 340B pharmacy operations. - Ensures compliance with 340B Program requirements for qualified patients, drugs, and locations. - Monitors and audits state Medicaid claims to ensure compliance to prevent potential duplicate discount rebates. - Uses Excel or a comparable data management program to filter out non-eligible transactions, including, but not limited to, drugs used to treat patients during inpatient care, Medicaid patients, drugs provided free by manufacturers, those provided at non-eligible locations, or prescriptions written by non-eligible providers. - Evaluates patient eligibility for qualified and non-qualified patients in mixed-use areas and clinics by reviewing patient medical records, insurance plans and, if applicable, hospital status. - Ensures that facilities maintain adherence to 340B Program regulations and guidelines. - Develops and fosters working relationships with internal working counterparts (e.g., IT, internal audit, accounting, etc.) to facilitate productive exchanges of information, to improve program efficiency and promote program compliance. Provides data, information and reports as needed for other business units within the organization. Program Enhancement/Optimization - Develops a thorough understanding of the 340B Program and improves its overall efficiency, value and internal support. - Assesses opportunities for cost savings and system improvements to yield higher compliance. Evaluates and implements cost savings opportunities. - Continues to build knowledge of the health care and pharmacy services industry. Uses that knowledge to identify ways and make recommendations to improve the 340B Program. - Provides assistance to all customers to clarify requirements and propose sourcing options. Evaluates and recommends the best sourcing solution. Reporting - Develops reports that can be used to educate staff and assist management in tracking the overall financial impact to the organization. Builds other reports, as appropriate, to monitor and improve 340B Program compliance and performance. - Maintains copies of reports for compliance and audit purposes. - Collaborates with the Pharmacy, Compliance and 340B governing board to develop monthly, quarterly and yearly audit metrics. - Constructs appropriate financial metrics to assess areas of improvement. - Develops and updates 340B Program reporting packages detailing volume, financial value and other reporting metrics as needed. - Uses provided tools to monitor prescription data, patient data, hospital data, payer data, site of care and, if required, ICD-10 codes. Summarizes and reports results to the appropriate individuals. - Monitors, reports, and analyzes contract pharmacy 340B activities. Provides financial reports to hospitals or other covered entities relative to financial impact and liabilities. Makes recommendations that would improve efficiency. - Performs covered entity-specific gross financial analysis and makes recommendations to improve program performance. Tracks financial impact over time, identifies root causes of adverse trends and makes recommendations to improve the program's financial stability. - Reviews and refines monthly 340B cost savings reports detailing purchasing and replacement practices, as well as dispensing patterns. Purchasing/Inventory/Split-Billing Duties - Provides coverage for the Pharmacy Buyer as necessary. - Analyzes and audits invoices, shipping and inventory processes. Makes recommendations for purchasing practices as needed. - Develops a thorough understanding of the split-billing/third party administrator systems and the functions to be performed.

Common Expectations:

Demonstrates a commitment to patient, visitor and staff by: complying with all applicable safety regulations; learning the impact of medical errors and methodologies that will lead to reduction of errors; reporting actual and potential errors, as well as hazardous conditions; identifying opportunities to standardize processes and "error proof" systems that will lead to increased safety; and participating in safety education programs and root cause analyses as required. Maintains established policies and procedures, objectives, quality assessment, safety, environmental and infection control standards. Participates in educational programs and inservice meetings. Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Required for All Jobs:

Performs other related duties as identified. WellSpan Health has adopted and implemented a compliance program to support WellSpan's values and standards for professionalism, integrity, and ethics. Expected to support and meet the values and standards of the organization and the performance expectations of the job, the department, and the compliance program. WellSpan Health has adopted and implemented a privacy program to safeguard the patient information and the business and operational information of the organization. Expected to support and meet the values and standards of the organization to safeguard patient and business/operational information.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

Physical Demands:

Standing - Frequently Walking - Frequently Sitting - Occasionally Carrying/Lifting - Rarely (10lbs) Pushing/Pulling - Rarely (10lbs) Kneeling/Crouching - Rarely Reaching - Occasionally Talking - Frequently Hearing - Frequently Repetitive Motions - Frequently Eye/Hand/Foot Coordination - Frequently

Working Environment:

Occupational Hazards - Occasionally

Qualifications

Minimum Education:

High School Diploma or GED Required

Work Experience:

2 years Including at least 1 year working with healthcare applications or technologies. Required

Licenses:

Certified Pharmacy Technician Upon Hire Required

Knowledge, Skills, and Abilities:

Ability to learn new technologies and software programs. Excellent communications skills and interpersonal skills. Proficiency in Microsoft Excel and general computer skills including accurate and efficient entry and navigation in multiple software systems. Organizing and managing multiple priorities.

Comprehensive Health Benefits

Flexible spending and health savings accounts Retirement savings plan Paid time off (PTO) Holidays Short-term disability Education assistance Financial education and support, including DailyPay Wellness and Wellbeing program Caregiver support via Wellthy Financial Wellness via SmartPath Childcare referral service via Wellthy You’re unique and you belong here.

At WellSpan Health, we are committed to treating all applicants fairly and equitably, regardless of their job classification. If you require assistance or accommodation due to a disability, please reach out to us via email at . We will evaluate requests for accommodation on a case-by-case basis. Please note that we will only respond to inquiries related to reasonable accommodation from this email address. Rest assured, all requests for assistance or accommodation are handled confidentially, allowing applicants to share their needs openly and honestly with us.