WVU-340B Audit & Compliance Analyst - Remote

WVU-340B Audit & Compliance Analyst - Remote

Apply for the WVU-340B Audit & Compliance Analyst - Remote role at WVU Medicine.

This position is responsible for assisting with the coordination of the 340B Drug Pricing Program for all qualified entities throughout the WVU Medicine Health System. The primary focus of this position is to review operating and regulatory compliance procedures and controls to ensure proper application of laws and requirements are met for continued eligibility for the 340B Program. Such review includes ongoing internal audit functions, data analysis, and operation review.

Independent audits and appraisals are designed to assist the leadership of WVUHS to meet the 340B Drug Pricing Program goals of regulatory compliance, program effectiveness and program excellence.

Education, Certification, and/or Licensure:

• High School Diploma or Equivalent.
• Apexus Advanced 340B Operations Certificate.

Experience:

• Three (3) years of healthcare, finance, or pharmacy experience.
• One (1) year of 340B or finance experience.

Education, Certification, and/or Licensure:

• Associate’s or Bachelor’s degree in Information Technology, Business Management, or Hospital Administration.
• Nationally Certified Pharmacy Technician through the Pharmacy Technician Certification Board.

Experience:

• 340B Drug Pricing Program experience.
• Experience in data analysis, audit process and reporting.
• Hospital or retail pharmacy experience.

The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

• Develop systems and processes to limit program liabilities and provide proper audits to identify risk and prevent duplicate discounts and diversion.
• Review and monitor utilization records and 340B purchasing accounts to ensure software or tools are working properly and accurately, performing audits or compliance assessments to validate processes.
• Monitor monthly and annual reports on 340B Program participation which clearly documents utilization, savings, problem areas and exceptions or discrepancies.
• Perform monthly compliance audits of contract pharmacies, hospital owned retail pharmacies, specialty pharmacies and hospital mixed use pharmacy to ensure that all 340B HRSA regulations are upheld.
• Perform monthly compliance audits of patient eligibility, provider eligibility, and location eligibility.
• Monitor purchasing records where 340B participation occurs, clearly documenting utilization, savings, problem areas and exceptions or discrepancies, to be shared with pharmacy leadership, Finance and Administration.
• Maintain 340B Program software to ensure appropriate products are mapped to the appropriate charge code and in the correct ratio, and maintain system when new charge codes are created.
• Be responsible for daily maintenance of the 340B Split Billing Software, including testing and validation and its communication with the pharmacy software.
• Monitor purchases for contract compliance, 340B compliance, and accurate pricing.
• Assist WVUHS covered entities with reporting, data requests and other inquiries as necessary.
• Upload purchase data to 340B Split Billing Software on a monthly basis for all purchases made outside of the wholesaler.
• Perform monthly audit to verify mapping is correct in the 340B Split Billing Software.
• Provide purchasers throughout the system with information and assistance needed to place orders using the appropriate accounts to maximize the 340B benefit.
• Review product accumulation in split-billing software to ensure proper accumulations and identify negative trends.
• Review ineligible claim data to ensure maximum benefit and identification of third-party administrator claim processing issues.
• Be responsible for single dose vial reporting and monthly input of single dose vial waste into split-billing software.
• Be responsible for updating any changes to charge code billing units from Epic into the split-billing software for accuracy and consistency.
• Create ad hoc reports to support program optimization and compliance.
• Perform targeted audits, negative audits, referral process development and review suspect pending claims to find additional eligibility.
• Complete accumulator reviews and targeted audits to ensure compliance.

• May be required to sit for long periods of time.
• Extended periods of computer and telephone usage.
• Must be able to move throughout the department work areas.

• Standard office environment.

• Ability to handle and maintain confidential information.
• Ability to work independently or cooperatively as a team member.
• Ability to adapt to various workloads and assignments.
• Must possess analytical and problem-solving skills.
• Must have effective verbal and written communication skills, as well as interpersonal…