Key skills
Critical Thinking
About this role
Role Overview
- Responsible for achieving in-depth knowledge of the 340B Program and providing expert audit direction to staff and management regarding the 340B Program.
- Maintains up-to-date knowledge of Geisinger’s 340B eligible locations, contract pharmacy network, procedures on 340B purchasing processes, and provides accurate and efficient audits to identify risk and prevent duplicate discounts and diversion.
- Routinely reviews 340B Program policies and procedures and offers contributions and changes to ensure 340B compliance.
- Ensures compliance with 340B drug purchasing, monthly auditing, split-billing software maintenance, contract pharmacy and mixed-use audits, and all areas of program compliance.
- Performs audits on a scheduled basis; to ensure compliance with the federal regulations of the 340B program.
- Evaluates patient eligibility for qualified and non-qualified patients by reviewing patient medical records, insurance plans, and hospital admission status.
- Performs chart and medical record review to verify necessary patient, provider, and medication information to ensure proper claim submission, and maintain accurate documentation of records related to 340B program.
- Ensures standard operating procedures are being followed and monitor all drug purchases on the GPO, WAC, and 340B accounts.
- Monitors compliance across points of service where 340B participation occurs.
- Develop a thorough understanding of split-billing systems and performs basic crosswalk maintenance.
- Performs spot audits and compliance assessments to confirm accuracy of charge descriptions, utilization data, and reorder reporting.
Requirements
- High School Diploma or Equivalent (GED)
- (Required)
- Bachelor's Degree
- (Preferred)
- Minimum of 4 years-Related work experience (Required)
- Minimum of 1 year-Healthcare (Required)
- Skills: Business Analysis, Critical Thinking, Healthcare Industry
Benefits
- Healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.