340B Pharmacy Compliance Specialist

TJ Regional Health.com

Office

Glasgow, Kentucky, United States

Full Time

Job Summary

This position is responsible for ensuring program compliance for TJ Regional Health Pharmacy Services within the 340B Drug Pricing Program and controlled substances diversion monitoring. Individual will work collaboratively with the Director of Pharmacy, 340B Coordinator, and other stakeholders to lead comprehensive audits and internal controls for 340B and controlled substances diversion monitoring, as well as support Departmental revenue cycle and other key initiatives.

Job Requirements

Minimum Education

High school diploma or equivalent required.
BS or BA degree from an accredited college or 3-5 years of relevant experience in related healthcare field/Pharmacy desirable.

Minimum Work Experience

Experience with the 340B program and its compliance requirements preferred.
Experience with billing/coding, auditing, or health care compliance preferred.
Knowledge of health care and/or pharmacy operations preferred.

Required Skills

Interpersonal Skills:

Ability to maintain inter- and intradepartmental relations. Accuracy in following directions. Willingness to work under indirect supervision.

Essential Technical/Motor Skills:

Proficiency in Microsoft Office software, such as: Word, Excel required
Proficiency in 340B split billing software
Ability to navigate patient health records

Requires constant mental concentration to details and frequently cope with deadlines. Must be able to read, write and communicate in an effective manner. Analytical skills to sort medications and pharmaceutical supplies, make minor calculation, maintain records and inventories, measure and comprehend medical technology and terminology.

Functional Demands

Physical Requirements

Sitting - 16-31%

Walking - 16-31%

Standing - 16-31%

Bending/Squatting - 1-15%

Climbing/Kneeling - 1-15%

Twisting - 16-31%

Visual and Hearing Requirements

Must be able to see with corrective eye wear.

Must be able to hear clearly with assistance.

Physical/Environmental Demands

Lifting - 0-50 lbs, 50 or more with assistance

Carrying - 0-50 lbs, 50 or more with assistance

Pulling - Up to 100 lbs

Pushing - Up to 100 lbs

Osha Category

Minimal potential for direct exposure

Essential Functions

340B Program Compliance (75%)

Develop and foster working relationships with internal working counterparts (IT, internal audit, results, accounting, and others) to facilitate productive exchanges of information to improve program efficiency and promote program compliance. Provide data, information, and reports as needed for other business units within the organization.
Be involved in any and all 340B audits.
Monitor and audit state Medicaid claims to ensure compliance to prevent potential duplicate discount rebates.
Using Excel or a comparable data management program, 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.
Evaluate patient eligibility for qualified and non-qualified patients in mixed-use areas and clinics by reviewing patient medical records, insurance plans, and hospital status.
Ensure that facilities maintain adherence to 340B Program regulations and guidelines.
Perform audits on a scheduled basis; may involve presenting and resolving reconciliation issues as they arise during the monitoring and reconciliation process.
Perform monthly audits of contract pharmacies.
Perform monthly self-audits of 340B pharmacy operations.
Ensure compliance with 340B Program requirements for qualified patients, drugs, and locations.
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 340B compliance within workflow processes.
Ensures compliance with all aspects of the 340B Program and implements all applicable aspects of HRSA’s Office of Pharmacy Affairs guidance, as well as organizational policies and procedures.
Evaluates covered entity compliance at the contract pharmacy, covered entity, and wholesaler levels.

Program Enhancement/Optimization:

Develop a thorough understanding of the 340B Program. Strive to consistently improve the overall efficiency, value, and internal support of the 340B Program.
Assesses opportunities for cost savings and system improvements to yield higher compliance.
Continue to build knowledge of the health care and pharmacy services industry, and use that knowledge to identify ways and make recommendations to improve the 340B Program.

Reporting

Maintain copies of reports for compliance and audit purposes.
Collaborate with the Pharmacy, Compliance, and 340B Oversight council to develop monthly, quarterly, and yearly audit metrics.
Use provided tools to monitor prescription data, patient data, hospital data, payer data, site of care, and, if required, ICD-10 codes. Summarize and report results to the appropriate individuals.
Prepares and assists in the monitoring and various tracking and reporting measurements to ensure compliance with the program.

Policy and Procedure Development

Review 340B Program policies and procedures on an ongoing basis and offer contributions and changes to ensure 340B compliance.
Develop systems and processes to limit program liabilities and provide proper audits to identify risk and prevent duplicate discounts and diversion.
Ensures that the 340B pharmacy program is continuously compliant with 340B federal regulations.

Rules/Guidance Surveillance

Split-Billing and Contract Pharmacy Software Maintenance

Develop a thorough understanding of the split-billing system and the functions to be performed.
Periodically performs spot audits or compliance assessments in specific areas and specific products to ensure that the CDM is accurate, charges are coming across accurately, and the utilization numbers are translating accurately into report for 340B reorders.

Controlled Substances Diversion Monitoring and Prevention (25%)

Provides oversight and direction for the organization’s medication diversion surveillance program and maintains comprehensive program to detect potential medication diversion.
Develops audit processes and conducts regularly scheduled audits to identify medication diversion in the various medication use processes within the health system.
Optimizes the use of reports and functionality of available technology (i.e., third-party diversion detection software, automated dispensing cabinets) to prevent and identify medication diversion.
Performs trend analysis and assessments of available information to identify medication diversion activities.
Oversees the investigation process of suspected medication diversion incidents in conjunction with Director of Pharmacy and other stakeholders.
Provides support for the organization’s controlled substances management committee and drug diversion response.
Participates in continuous improvement, education, and planning activities. Oversees and provides related guidance to staff.

Organizational Expectations

T.J. Pledge

I Will Show Compassion

see all patients, family members, coworkers, physicians, and anyone else at T.J. as my customer.
recognize that each and every interaction I have at T.J. Regional Health matters
show kindness and compassion towards my customers at all times
be sensitive to the personal and private needs of every customer

I Will Cooperate With Others

maintain zero tolerance for abusive behavior
listen and be willing to accept fault when I make a mistake
never underestimate the power of an apology
refrain from blame and judgment
bring a sense of calm to stressful situations

I Will Collaborate With Others

value myself and every coworker as an equal part of one GREAT team working together
treat others in a way that I would like to be treated
participate only in conversations that are courteous, respectful, and reflect positively on my teammates and T.J. Regional Health
foster a calm and pleasant atmosphere, and refrain from gossip, rumors, and insults
speak honestly, seek truth, and act with integrity towards my teammates
value the uniqueness and expertise that each team member contributes to the whole
meet the need of the moment, regardless of whether or not it is considered part of my job

I Will Communicate

smile - at everyone
always introduce myself, my role, and my purpose use body language, eye contact, and tone of voice that shows respect in every interaction
follow the 10/5 rule: always acknowledging people at 10 feet away with a smile and always greeting people at 5 feet away
escort any customer in need (visitors, patients) to their destination

I Will Adapt To Change

be a part of the solution when I am presented with a challenge
embrace change and set the example for those around me
accept openly when there are changes that T.J. Regional and/or I have no control over
manage the expectations of others by explaining duration and next steps as often as needed

I Will Be A Champion

-Serve With Passion

view myself as an owner of T.J. Regional Health and act accordingly
take responsibility for the physical appearance of T.J. Regional Health, including my work area
go out of my way to daily thank and compliment my customers and coworkers
dare to make a difference and be exceptional
constantly try to improve myself and T.J. Regional Health
speak positively about T.J. Regional, while at work and in public places outside of work