340b Program Integrity Specialist-Pittsburg, KS


POSITION:  340b Program Integrity Specialist

DEPARTMENT: Corporate Compliance

REPORTS TO: Director of 340(b) Compliance

DIRECT REPORTS: As Assigned

FLSA STATUS: Exempt

CORE VALUES

The core values of Community Health Center of Southeast Kansas, Inc. (CHC/SEK) are dignity and stewardship.  Each staff member is expected to perform their job duties in a way that preserves dignity for our patients and maintains good stewardship of the CHC/SEK’s resources.

GENERAL DESCRIPTION

This position has responsibility assisting with pharmacy contracting and auditing tasks, and works directly with CHC/SEK’s Compliance Team.  This position is responsible for overseeing the contracting with CHC/SEK’s in-house pharmacies (Apothecare Pharmacies) are appropriately and timely completed, while assisting with 340b auditing requirements related to CHC/SEK’s in-house pharmacies and contract pharmacies.

ESSENTIAL DUTIES

Pharmacy Contracting:

  1. Completes in-house pharmacy credentialing tasks associated with the Kansas Board of Pharmacy, the Drug Enforcement Agency, and other state and federal agencies (e.g. Medicare and Medicaid) to ensure all in-house pharmacies are functioning lawfully in the State of Kansas and, as needed/appropriate, the State of Oklahoma.
  2. Completes contracting tasks associated with private insurance enrollments for all in-house pharmacies.
  3. Addresses problems with payers regarding timeliness of approvals and works with the payer to find a resolution.

Pharmacy Auditing:

  1. Maintains a thorough understanding of CHC/SEK’s 340B program structure and requirements in order to ensure compliance in regard to qualified patients, providers, vendors, payers, and locations.
  2. Actively engages in the implementation of new and ongoing 340B-related projects at all clinic sites, in-house pharmacies, and contract pharmacies.
  3. Assists with 340B self-audits, including, but not limited to: monthly clinic-administered drug audits at all CHC/SEK facilities, monthly audits at all CHC/SEK in-house pharmacies, and monthly audits of all CHC/SEK contract pharmacies.
  4. Generates documentation and oversees recordkeeping of internal audit activities of the 340B program, including, but not limited to: internal audit worksheets, audit reports, electronic medical record documentation and prescription hardcopies supporting audit sample compliance, and reports requested from other staff in supporting program compliance as-needed.
  5. Monitors prescription data, patient data, payer data, site of care, and ICD-10 codes.
  6. Monitors and audits state Medicaid claims to ensure compliance to prevent potential duplicate discount rebates.
  7. Monitors and filters non-eligible 340b transactions.
  8. Evaluates patient eligibility for qualified and non-qualified patients in clinics by reviewing patient medical records, insurance plans, and facility status.
  9. Assists in evaluating if CHC/SEK facilities are maintaining adherence to 340B Program regulations and guidelines, including, but not limited to: appropriate storage of 340B inventory and reconciliation of 340B inventory.
  10. Performs audits on a scheduled basis; may involve presenting and resolving reconciliation issues as they arise during the monitoring and reconciliation process.
  11. Perform all duties, services and documentation in full compliance with CHC/SEK policies and procedures.
  12. Performs other duties as assigned.

QUALIFICATIONS

  1. Associates Degree or equivalent required.
  2. Work experience in a pharmacy or healthcare setting preferred.
  3. Completion of Apexus 304b University upon hire.
  4. Any combination of education and work experience that would likely provide the required knowledge and abilities is qualifying.

KNOWLEDGE, SKILLS AND ABILITIES

  1. Social and cultural sensitivity appropriate to ethnically and economically diverse patient-and employee-base.
  2. Communicates through appropriate channels. Use proper chain of command for patient complaints.
  3. Ability to handle emergency situations calmly and effectively.
  4. Must have high attention to detail.
  5. Must have good written skills.
  6. Must be self-motived and have good self-monitoring skills.
  7. Must be computer literate and be proficient with Excel.
  8. Must be able to maintain good inter-personal relationship with co-workers and other members of the health care team and the organization.
  9. Provide customer service in accordance to the organization’s mission.
  10. Be courteous and respectful when interacting with co-workers and others outside the organization.
  11. Maintain patient confidentiality in accordance to organization’s policy and procedure and HIPAA requirements.

WORKING CONDITIONS

While performing the duties of this Job, the employee is regularly required to sit; use hands and fingers to operate computer keyboard, handle, or feel; reach with hands and arms and talk or hear. The employee is occasionally required to stand.  The employee may occasionally lift and/or move up to 10 pounds.  Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception and ability to adjust focus. Computer work is frequent. Good lighting and comfortable temperature of ventilation at all times