JOB
The 340B program analyst/Certified Pharmacy Technician (340b CPhT) works under the direction of the 340B program coordinator and the general direction of the System Director of Pharmacy Services. This Associate, builds, tests, implements and analyzes drug dictionary, chargemaster, orders and claims for 340b program eligibility. This Associate is responsible for mapping of drugs and chargemaster CDM codes in Meditech and 3rd party administration platforms, identifying non-340b items, blacklisting items, and maintaining eligible provider files.
The Associate evaluates for accurate NDC and pricing. The Associate conducts internal compliance audits and reports findings to the 340b Program coordinator and ultimately the Corporate Compliance Committee, System Director of Pharmacy and Authorizing officials at each covered entity. The Associate submits eligible 340b claims data from contracted pharmacies to manufacturers per external vendor service (ESP) and to Kentucky Medicaid.
The Associate evaluates eligibility of claims for referral capture. The Associate gathers and submits 340b claims data to manufacturers for 340b rebate capture. The Associate tracks capture % of rebates for restricted drugs.
The Associate coordinates the ordering and executes distribution of 340b medications to affiliated contract pharmacies under the alternative distribution process. The Associate processes and codes billing invoices from contract pharmacies for payment and reconciles and codes payments when necessary. The Associate evaluates cost saving opportunities based on contracted savings of specific inventory products and makes recommendations to RPM committee.
Adheres to the Kentucky Board of Pharmacy Care Scope of Practice. Exhibits the F. I.
R. S. T. values (Friendliness, Innovation, Respect, Service, and Trust).
, DUTIES AND
Analysis of claims data for appropriate processing and savings. Accountable for problem solving and critical thinking, appropriately escalating concerns to 340b Program coordinator or System Director of Pharmacy. Serves as an advocate for the 340b program and a resource for CE and child sites.
Competent in use of 340b split billing software system and third party administrator platforms for claims processing and accumulators. Compiles and analyzes data using Excel and Google docs to ensure compliance with 340b program requirements. Presents financial and analytical data within Excel, Word or google documents.
Creates monthly reports on cost savings and revenue from 340b program. Audits pharmacy claims, medical records information and pharmacy purchases for compliance with the 340b program requirements. Monitors 340b purchases and 340B pricing through the wholesaler for any pricing discrepancies in the retail, hospital and contracted pharmacies.
Provides suggestions to EMH owned pharmacies on NDC options to improve accumulation, split to 340b account and improve 340b: WAC purchase ratio. Processes and codes contracted pharmacy invoices for payment by Accounts payable when necessary. Participates in inventory management by splitting, sending and receiving pharmacy orders from 340b and non-340b accounts, managing NDC matching, new dictionary purchases or temporary purchases for backordered products.
Monitors and reviews rejected/ineligible claims for eligibility, documenting referrals or updating provider status, and communicates with TPAs regarding reprocessing of any eligible claims or missed opportunities as appropriate. Submits required data elements of claims to external vendors, including manufacturers designated administrative platform (ESP), Kentucky Medicaid or manufacturers rebate platforms. The 340b CPhT monitors and tracks capture percentage, rebate dollars and revenue.
Monitors manufacturers designated administrative platform (ESP) and rebate platform for any “at risk” pharmacies or drugs and submits data as indicated to prevent loss of 340B benefit. Evaluates drug manufacturer policies for updates or drug/NDC additions, makes designations on ESP as necessary, and communicates designation or configuration changes with contracted pharmacy and TPAs. Assists with contracted pharmacy enrollment, wholesale account set up, TPA implementation, or revenue analysis from contracted pharmacy.
Participates with external or HRSA auditors. Maintains 340B knowledge and changes to the program (i.e. legislative changes) by attending trainings or webinars held by 340B organizations, vendors, consultants, legal counsel, or collaborative groups. Review 340B related policies and procedures on an ongoing basis and update accordingly to ensure program compliance and integrity.
Complies with medication management standards and Organizational policies and procedures for safe and effective handling, preparation and administration of medication within scope of practice. The Associate has keen eye for detail and ability to detect subtle differences in products, NDC or CDM numbers, unit of measure calculations and extraction of key elements for audits. Generates requested 340b related reports upon request.
Performs other tasks as assigned. WORKING CONDITIONS, HAZARDS AND PHYSICAL EFFORT: Works in a well-lighted, ventilated and air conditioned area. Long periods of sitting, standing, or bending are required.
Risks exposure to disease, infection and physical strain. Must be able to lift 20 lbs. independently. May work from home for specific assignments with supervisor’s approval.
Not to exceed 25% of shifts without Director’s approval. CONTACTS WITH OTHERS: Pharmacy Associates, physicians or other healthcare providers, community resource personnel, administrative staff, financial staff, information services staff and hospital support services. External vendors associated with 340b program, contracted pharmacies, TPAs, Kentucky Medicaid, 340b consultants and HRSA/OPA.