Responsibilities
- Designs and implements systems to reduce program risks and conducts audits to identify and prevent duplicate discounts and diversion.
- Examines and tracks utilization records and 340B purchasing accounts to ensure software functionality and accuracy, performing audits or compliance assessments to validate processes.
- Reviews monthly and annual reports on 340B Program participation, documenting utilization, savings, problem areas, and discrepancies.
- Conducts monthly compliance audits of various pharmacies to ensure adherence to 340B HRSA regulations.
- Performs monthly compliance audits of patient, provider, and location eligibility.
- Monitors purchasing records where 340B participation occurs, documenting utilization, savings, problem areas, and discrepancies, to be shared with relevant departments.
- Maintains 340B Program software to ensure appropriate product mapping and system updates.
- Handles daily maintenance, testing, and validation of the 340B Split Billing Software and its communication with pharmacy software.
- Monitors purchases for contract and 340B compliance, and accurate pricing.
- Assists covered entities with reporting, data requests, and other inquiries as needed.
- Uploads purchase data to 340B Split Billing Software monthly for all non-wholesaler purchases.
- Performs monthly audits to verify mapping accuracy in the 340B Split Billing Software.
- Provides information and assistance to purchasers to maximize 340B benefits.
- Reviews product accumulation in split-billing software to ensure proper accumulations and identify negative trends.
- Reviews ineligible claim data to ensure maximum benefit and identify third-party administrator claim processing issues.
- Manages single dose vial reporting and monthly input of single dose vial waste into split-billing software.
- Updates any changes to charge code billing units from Epic into the split-billing software for accuracy and consistency.
- Creates ad hoc reports to support program optimization and compliance.
- Conducts targeted audits, negative audits, referral process development, and reviews suspect pending claims to find additional eligibility.
- Completes accumulator reviews and targeted audits to ensure compliance.
Compensation
Not specified
Work Arrangement
Remote
Team
Healthcare
Other
- Scheduled Weekly Hours: 40
- Shift: Exempt/Non-Exempt: United States of America (Non-Exempt)
- Cost Center: 248 SYSTEM 340B Pharmacy Admin
Not specified
