Analyst, 340B Program - Contract Pharmacy

REQUIRED EDUCATION / EXPERIENCE:

• Associates degree or equivalent related work experience

• 2 years of related work experience

• Apexus 340B University

PREFERRED EDUCATION / EXPERIENCE:

• Bachelor's degree in business, accounting or finance

• 3 years' experience with pharmacy 340B Drug Pricing Program

• 3 years' experience in business and analytics

• Working knowledge and understanding of medication and contract terminology; healthcare insurance collections, reconciliation, or analysis; supply chain management

• EPIC experience

• Apexus Advanced 340B Certificate Program

   

KNOWLEDGE / SKILLS / ABILITIES:

• Proficiency in Microsoft Office tools particularly Excel with a proven ability to analyze and make sense of large datasets

• Ability to quickly master new software

• Excellent analytical skills with outstanding attention to detail including the ability to identify issues, obtain relevant information, relate and compare data from different sources, and identify solutions

• Excellent organizational skills, project planning and time management skills to prioritize and coordinate timely completion of duties and concurrent projects

• Ability to create and maintain policies and procedures

• Strong business/professional written and verbal communication skills

• Ability to work and interact with multiple stakeholders

• Self-starter with experience working independently as well as within teams in a highly collaborative environment

JOB SUMMARY:

Under the direction of the 340B Program Manager, this position oversees the day-to-day operations, compliance monitoring, and auditing of the University’s 340B Drug Pricing Program. Collaborates with the Purchasing Manager and Senior Procurement Officer to monitor ordering processes to ensure pharmacy supply chain management is consistent with established inventory split billing software practices, compliant with 340B Program rules, there are no GPO (group purchasing organization) prohibition violations, and inventory management is optimized to maximize benefits.  Performs audits including claim analysis to determine if use is compliant per the 340B regulations and to ensure prevention of duplicate discounts and drug diversion to ineligible patients. Prepares self-audit reports.  Ensures records and documentation for the 340B program are thorough and accurate.

This role will require the ability to analyze large data sets, clearly summarize the results for leadership, be able to speak to the results at both a detailed and high level, and recommend appropriate next steps to resolve any identified variances. Responsible for appropriately escalating issues and tracking to resolution, and participating in routine meetings with multiple areas of the organization as well as external entities.

ESSENTIAL JOB FUNCTIONS:

• Develops a thorough understanding of the 340B Program. Strives to consistently improve the overall efficiency, value, and internal support of the 340B Program.

• Maintains knowledge of, and complies with, all relevant laws, regulations, policies, procedures, and standards including all HRSA Office and Pharmacy Affairs regulations related to the 340B Drug Pricing Program.

• Maintains up-to-date policies and procedures on 340B purchasing and inventory processes.

• Provides proactive education to staff on policies and procedures related to inventory management, split billing software, and 340B procedures including staff at contract pharmacies, clinics, and UTMB-owned pharmacies.

• Effectively communicates to wholesalers, pharmacists, leaders, and others as needed.

• Build reports to monitor and improve 340B program compliance and performance.  Maintains copies of reports for compliance and audit purposes.

• Participates in on-site mock HRSA audits with consulting firm and HRSA audits.

• Collaborates with the pharmacies and 340B Team to develop monthly, quarterly and yearly audit metrics.

• Performs audits on a scheduled basis including presenting and resolving issues as they arise during the monitoring and reconciliation process. 

• Use the electronic health record (EPIC) to research patient encounters and records within the specified audit period.  Documents and identifies whether the encounter was with an eligible physician, at an eligible location, and eligible patient status.

• Monitors and audits state Medicaid prescriptions to ensure compliance to prevent potential duplicate discount. Performs audits to ensure split billing software accumulators are accurate on an NDC level; performs physical inventory cycle counts as needed to verify the drug accumulations and/or NDC’s. 

• Develops a thorough understanding of the 340B Third Party Administrator software and the functions to be performed.  Reviews and monitors utilization records, 340B purchasing accounts, and contract pharmacy usage to ensure software and tools are working properly and accurately.

• Reviews contract pharmacy invoices prior to final approval; compiles and prepares invoices for the amount due to 340B Third Party Administrator; reviews amount due from contract pharmacy and follows up on discrepancies or past due amounts.

• Develops a thorough understanding of the split billing software and the functions to be performed. Reviews and monitors utilization records, 340B purchasing accounts, and pharmacy usage to ensure software and tools are working properly and accurately.

• Performs other information systems related duties and responsibilities as assigned or defined.

• Monitors and coordinates purchasing records for each cost center where the 340B accounts apply to ensure the GPO Prohibition rule is followed, WAC purchases are minimized when allowable, and updates the split billing software with any direct purchase data.

• Provide buyers with information needed to place orders using the appropriate accounts (e.g., WAC, GPO, and 340B) to replenish inventory in the mixed-use inventory setting. 

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

• Partners with Pharmacy and IS to ensure NDC’s are current in the hospital software as well as the split billing software.

• Partners with IS and RCO departments to ensure claims are going out with the correct modifiers and claim data.

• Adheres to internal controls and reporting structure.

MARGINAL OR PERIODIC JOB FUNCTIONS:

• Performs related duties as required.

• Hybrid work arrangement requiring both remote work and periodic on-site presence at the Galveston campus, other campuses, or travel to CMC to support operational needs and team collaboration.