Position Summary<?xml:namespace prefix = "o" ns = "urn:schemas-microsoft-com:office:office" />
The Reimbursement & Compliance Analyst is responsible for:
340B Contract Pharmacy Coordination
Policy and Procedure Development
Self-Audits (including external contract pharmacy)
Retail Pharmacy Reimbursement & Compliance
Third Party Claim Reconciliation and analysis
Third Party Contract Monitoring
Drug Profitability Analysis
Ryan White Program compliance & reporting
ADAP Program compliance & reporting
Education Bachelor's degree
Experience 340B experience preferred; Retail Pharmacy experience preferred; minimum of 3 years full-time hospital practice experience; EPIC experience preferred; Highly proficient in Microsoft Office with an emphasis in Microsoft Excel; leading small groups to facilitate outcomes, communicating outcomes to hospital leadership, auditing for compliance, analyzing financial impact of a department/business unit
340B university (must be completed within 1 year of hire date)
Core Job Responsibilities
340B Contract Pharmacy Coordination & In-house Pharmacy Special Program Coordination (Ryan White, ADAP)
Serves as the institutional "compliance expert or authority" on 340B contract pharmacy regarding details, policies, and procedures of the virtual inventory processes required for mixed use areas. Actively engages with senior leadership and participates in decision-making processes related to the implementation of new 340B contract pharmacy processes. Responsible for evaluating, auditing and maintaining compliance and monthly reporting for Ryan White Program patients and ADAP enrolled patients.
1. Policy and Procedure Development
Develops and modifies 340B policies in accordance with state, federal, and system program requirements
Develops and modifies In-house pharmacy special program policies in accordance with state and system program requirements
Develops training and competency materials for all staff and leaders who work with the 340B program.
Conducts ongoing 340B program training for staff related to 340B, Ryan White, and ADAP compliance.
3. Rules/Guidance Surveillance
Ensures that the 340B Contract Pharmacy program is continuously compliant with 340B federal regulations.
Maintains knowledge of the policy changes that affect the 340B program, including, but not limited to HRSA/OPA rules and Medicaid changes.
Responsible for ensuring that the HRSA database is accurate for all Contract Pharmacies.
Develops, executes, and documents self-audits of the 340B Contract Pharmacy process. Coordinates and ensures remediation of findings.
Conducts and/or coordinates an annual audit of all contract pharmacies. Documents results and follow-up on any findings.
Monitors 340B compliance within workflow processes.
Performs daily/monthly audits of Ryan White and ADAP program enrollees.
6. External Audits
Serves as the point person and coordinator for all contract pharmacy audits. Coordinates all requests and responses. Maintains a current state of "audit readiness".
7. Contract Management
Evaluates all current and future contract pharmacy opportunities, including contract language, fee structure, data setup, and internal and independent external auditing.
Develops and maintains Special Program contracts In-house and New Services.
8. Program Enhancement/Optimization
Provides input and implements business plans in coordination with the organization's pharmacy leadership for organization facilities to help use 340B savings to expand and improve care provided to underserved and vulnerable patient populations; assists facilities prioritize and implement outpatient program development and contract pharmacy agreements related to 340B; and assists the organization's leadership with program development and optimization.
Participates in the development and implementation of reports generated on the 340B contract pharmacy program that outline savings, utilization, exceptions, and discrepancies.
Responsible for monthly Ryan White utilization reports to prepare Revenue Cost Share transfers with the Ryan White Clinic.
Responsible for monthly ADAP utilization reports to prepare monthly invoices to ADAP/DHEC.
Retail Pharmacy Reimbursement & Compliance
Responsible for Third Party Claim reconciliation and analysis. Uses available software tools to audit payment trends. Monitor claims adjudication trends to ensure Payer contract compliance. Monitors and reports Drug profitability trends to staff and pharmacy management. Develops and maintains relationships with software vendors, payers, and other related parties.