Analyst - 340B

SUMMARY:

Responsible for creating/revising specific 340B Program policy and procedures.  Ensures proper training and education for employees working on 340B quality assurance programs.  Completes timely self-audits for both 340B pharmacy operations and contract pharmacies.  Participates in any and all 340B Program audits. Ensures compliance with 340B Program requirements for qualified patients, drugs and locations.  Promotes and ensures overall organization compliance to 340B program.

ESSENTIAL FUNCTIONS:

1.    Policy and Procedure Development

·         Maintain up-to-date policies and procedures on 340B purchasing processes.

·         Develop systems and processes to limit program liabilities and provide proper audits to identify risk and prevent duplicate discounts and diversion.

·         Review 340B Program policies and procedures on an ongoing basis and offer contributions and changes to ensure 340B compliance.

2.    Education

·         Develop proper 340B quality assurance training for employees as appropriate.

o   Assign staff to 340B University OnDemand training based on their role/responsibility.

·         Provide proactive education to staff on policies and procedures related to inventory management and 340B procedures.

·         Expand professional development through related classes and seminars, current publications, and regional/national association membership participation.

3.    Self-Audits

·         Be involved in any and all 340B Program audits.

·         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.

·         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, if applicable, hospital status.

·         Ensure that facilities maintain adherence to 340B Program regulations and guidelines.

·         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.

4.    Program Enhancement/Optimization

·         Develop a thorough understanding of the 340B Program and improve the overall efficiency, value, and internal support of the 340B Program.

Assess opportunities for cost savings and system improvements to yield higher compliance.

·         Continue to build knowledge of the health care and pharmacy services industry; use that knowledge to identify ways, and make recommendations, to improve the 340B Program.

·         Evaluate and implement cost savings opportunities.

·         Assist all customers to clarify requirements and propose sourcing options; evaluate and recommend the best sourcing solution.

5.    Reporting

·         Develop reports that can be used to educate staff and assist management in tracking the overall financial impact to the organization. Build other reports, as appropriate, to monitor and improve 340B Program compliance and performance.