340B Auditor - Pharmacy - Biltmore Campus

JOB SUMMARY:

MAHEC is   seeking   to fill a full time and   benefitted   340B Program Auditor who   is responsible for   auditing MAHEC’s 340B Pharmacy Program. This position   is responsible for   ensuring compliance with state and federal requirements of a 340B program. This role will train in   person   and remote/hybrid work environment may be available after the   initial   training period. The ideal candidate will be regionally   located .

SPECIFIC RESPONSIBILITIES:

-
All required audits   / reports for the 340B Pharmacy Program are completed monthly per HRSA guidelines.

-
R e v i e w   340B Program   p o li c i es and p r o ce d u r es   o n an   o n g o i n g   b a s i s   a n d   o f f e r   co n tr i b u t i o n s   a n d ch a n g es   t o   e n s u r e   3 4 0B   comp li a n ce.

-
Develop a thorough understanding of the split-billing   /   third party administrator systems and the functions to be performed.

-
Audit prescription data, patient da ta, hospital data, payer data, site of care, and, if   required , ICD-10 codes. Summarize and report results to the Compliance Officer and the Director of the 340B Program.

-
Audit the purchasing process to ensure proper operation and compliance.

-
Audit invoices, shipping, and inventory processes.

-
P e r f o r m   m o n t h l y a u d i t s   o f   co n tr a c t p h a r m ac i es.

-
P e r f o r m   m o n t h l y audits   o f   3 4 0B p h a r m acy   o p era t i o n s.

-
Audit for   c o m p li a n ce   w i t h 340B Program   r e q u i r e m e nts   f or   q u al i f i ed   p a t i e n t s,   dr u g s,   a n d l o c a t i o n s.

-
A ud i t   s t ate   M e d i ca i d cl ai m s   t o   e n su r e co m p li a n ce   t o   p r e v e n t p o t e n t i al d u p li cate   d i sco u nt   r e b ate s .

-
U s i ng   E x cel or a   c o m p a r a bl e da t a   m a n a g e m e n t   p r o g r a m ,   f il t er   o u t   n o n - e li g i b l e   t r a n sa c t i o n s ,   i nc l u di n g , b u t   n o t   li m i t ed   t o ,   d r u g s   us e d   t o   t r e a t p a ti e n t s   d u r i ng   i n p ati e n t   c a r e,   M e di c a i d pa t i e n t s ,   d r u g s   p r o v i d e d   fr ee   by   m a n u f a c t u r er s ,   t h ose   pro v i d e d at n o n - e li g i b l e l o cati o ns,   o r   p r es c r i p t i o n s   w r i tt en   by   n o n- e li g i b l e pro v i d e r s.

-
Audit data   regarding   pa t i e n t   e li g i b ili t y   f o r   q u al i f i ed   a n d   n o n - q u a li f i ed   p a t i e n t s   i n   m i x e d - use   a r e a s   a n d   c li n i cs   by   r e v i e w i ng   p a t i e n t   m e di c a l   r ec o r d s ,   i ns u r a n ce   p l a n s ,   a n d , if applicable,   h o sp i t al   s t a t us.

-
Audit to e nsure   t h a t   MAHEC Pharmacies   m a i nta i n   adh e r e n ce   t o 340B Program   r e g u l ati o ns   a n d   g u i d eli n e s .

-
Compile reports, as appropriate, to monitor and improve 340B Program compliance.

-
Maintain copies of reports for compliance and auditing purposes.

This role description is a general description of the essential job functions .    It is not intended to describe all the duties the   340B   Program Auditor   may perform.

KEY COMPETENCIES:

-
Communication Skills

Effectively and respectably communicate with other individuals, whether it be a colleague, patient, or patient’s family member and appropriately   enumerate   information in a manner easily understood by all parties. We do this to foster a culture of understanding between all parties, especially in complex and   difficult situations , to   ultimately provide   the best care possible   to   our patients and their families.

-
Decision Making

Ability to make the most   appropriate decision   in a given   situation and then   taking   the next steps to ensure   appropriate   and   timely   completion. This requires conflict resolution skills, critical thinking skills , confidence   in your ability to make the right decision in most situations. This also includes   ability   to prioritize your workday appropriately to ensure the most important tasks are completed on time.

-
HealthCare Knowledge

Having the drive to keep yourself abreast and up to date on the new breakthroughs in your area of expertise and communicating them to the rest of the team, as appropriate .    This also includes keeping up with your licensure and yearly training requirements within your   area   exp ertise   along with MAHEC’s   organizational training. Finally, the ability to apply the depth of knowledge   maintained   and gained through this process in real life scenarios as   appropriate .

-
Interpersonal Skills

Showing the ability to meet   difficult situations   with grace, professionalism, and understanding. Within your area of expertise, showing respect and showing empathy where appropriate with your colleagues, patients, and their family at all times, even when   its   most difficult to do so. This is done, in part, by effective listening, being your authentic self, showing responsibility and dependability, and being patient with others.

-
Organizational Values

Adherence to MAHEC’s founding principles and incorporating them every day. This includes, among others, having integrity and accountability, reverence for other cultures and   equitable   practices,   ability   to manage change, and displaying a clear understanding of organizational dynamics. Doing these things creates a culture where people want to do   the   best for each other and gives personal ownership towards the goal of helping people in their time of need.

-
Problem Solving

Having an analytical mind and ability to work autonomously to solve complex problems that may arise. The wherewithal to think logically through a difficult problem and come to   an appropriate resolution   for a given issue. This helps to drive continuous improvement by thinking   through   where we can improve in a novel way. Measures success by   understanding where we are currently and where we want to go and then applying those   new ideas   to affect positive change.

SPECIFIED SKILLS

-
COMPUTER

-
Must have advanced computer skills including Microsoft Office Suite.

-
FOREIGN LANGUAGE

-
Spanish speaking skills preferred.

PHYSICAL DEMANDS

-
Light   - Moderate energy level: Lift and carry 25 - 35   lbs , Push/Pull 50 - 100   lbs   (empty bed, stretcher, etc.)

-
Physical Activity :   Occasional   ( 0   -   33 % of Workday)

SUPERVISORY RESPONSIBILITIES:

-
Not Applicable.

EDUCATION AND EXPERIENCE

-
MINIMUM QUALIFICATIONS:

-
Associate’s Degree in healthcare   or equivalent work experience and/or a minimum of three (3) years   of auditing experience .

-
PREFERRED QUALIFICATIONS:

-
340B Pharmacy Program experience and/or   Federally Qualified Healthcare   Organization (FQHC) experience   strongly   preferred.

-
Allscripts PM/EMR Pro software experience preferred.

DESIRED   LICENSES / CERTIFICATIONS :

-
Certified Pharmacy Tech (CPhT).

-
Registered Health Information Technic ian (RHIT) .

-
Certified Professional Medical Auditor (CPMA).

SCHEDULE:

• Regular attendance on-site is an essential function of this position. Typical business hours are Monday – Friday, 8:00 am to 5:00 pm (or flexed to best meet the needs of the clients and/or the Division);   40 hours   per workweek ;   Work hours will need to be flexible in order to respond to special work assignments, or evening activities, as requested by the team leader.

COMPENSATION:

• $29.90/hour + eligible for MAHEC Total Rewards Package

At MAHEC , we strive to equip all team members with Total Rewards (pay + benefits) to honor their service, support their health, manage their financial security, build their career, and thrive.

MAHEC is a qualifying employer for the Public Service Loan Forgiveness (PSLF) Program. Employees who meet federal requirements may be eligible to have remaining student loan balances forgiven after 10 years of qualifying payments while working full-ti