340b Program Coordinator - Retail Pharmacy - Full Time - 1st Shift

JOB SUMMARY:

Under the general direction of the Systems Director of Pharmacy, this Associate builds, tests, implements and educates end users about the 340B program for Ephraim McDowell Health covered entities, child sites and contract pharmacies. Reports compliance to Corporate Compliance Committee, System Director of Pharmacy and Authorizing officials at each covered entity. Responsibilities include maintenance of pharmacy chargemaster and Meditech drug dictionary, 340b split billing platform, Shelter alternative distribution program, Beacon MFP/rebate claim discrepancies, 340b Referral claim processing, Tracelink DCSCA, director vendor and wholesaler ordering system, interfaces and 340b related policies and procedures. Responsibilities also include claims submission and reporting requirements to 340B ESP and Kentucky Department of Medicaid Services to ensure consistent access to 340B pricing at entity owned/contract pharmacies and prevention of duplicate discounts. Keeps mapping current for all drug charge codes, provider dictionary, NDC products and locations in split billing system. Tracks expenses and revenue from 340b program and routinely evaluates program operations, contract pharmacy relationships, ineligible claims, fee structures, etc to maximize program compliance and net savings. Assists System Director of Pharmacy and System Retail Pharmacy and Ambulatory Care Manager in implementation of new retail pharmacies or new service lines affecting the 340B Program by completing enrollments with HRSA OPAIS, wholesaler account set up, TPA implementation, etc. Serves as a resource to Pharmacists, pharmacy inventory technicians, retail pharmacy technicians, providers, administrators, legal team, finance and business office Associates to develop and refine the 340b program integrity. Responsible for supervision, training and inspection of all inventory management processes performed by certified technicians. Directly supervises and trains 340b analyst/certified pharmacy technicians, outsourced support personnel, pharmacy inventory technicians or other contract pharmacy personnel involved in Shelter alternate distribution program. Annually updates 340b related policy and procedures. Serves as primary contact for covered entities/child sites on HRSA website, with authorizing officials for each covered entity, Fiscal auditors for Medicare Cost Reporting (BLUE) and with internal or external legal counsel (Hall Render). Provides 50% staffing component. Exhibits the F.I.R.S.T. values (Friendliness, Innovation, Respect, Service, and Trust).

ESSENTIAL FUNCTIONS, DUTIES AND RESPONSIBILITIES:

1. Compounds, dispenses, labels, delivers, secures, purchases and monitors use of medications for the patient to ensure the quality of patient care.
2. Supervises Pharmacy inventory technicians to ensure effective and efficient operations and compliance with 340b, GPO and WAC account purchasing from wholesaler or direct vendors.
3. Contributes to the efficient communications of the department. Coordinates necessary changes to inventory and formulary items with Clinical Coordinator and Pharmacist in Charge/Managers.
4. Maintains commitment to technical and professional growth and competency. Researches regulations, legislation and tools to maximize performance in the role. Attends local, state or national 340b programs to stay current. Attends external 340B legal counsel (Hall Render) webinars monthly and other webinars from 340B organizations or TPAs on current events. Shares information with Pharmacy team, Authorizing Officials, legal and inventory teams.
5. Develops orientation tools and evaluates competency skills for use of wholesaler order and invoicing portals, split billing software platforms, contract pharmacy administrative platforms and HRSA website by Pharmacy Associates.
6. Serves as administrative contact for IT implementation projects involving 340b program, data or platforms. Manages split billing software upgrades or implementations, changes in configurations, new 340b contract pharmacy expansion projects, including enrollment of eligible clinics or child sites and contract pharmacies. Coordinates and implements project and testing within given time frame and budget.
7. Maintains Meditech drug dictionary to be reflective of stocked inventory with NDC codes, pricing and chargemaster billing codes. Requests new drug item charge code from Finance team. Builds new drug item in Meditech and maps NDC and charge code (CDM) in split billing system. Maintains exportation of charge transaction and billing files.
8. Maintains the Meditech provider dictionary databases to be reflective of current credentialed providers for each covered entity and/or clinics. Maintains exportation of updated provider files to split billing platforms/contract pharmacy platforms.
9. Maintains appropriate mapping of eligible outpatient facility and clinic locations in 340b split billing system platforms and contract pharmacy platforms.
10. Reviews and seeks approval of required contracts for contract pharmacy partners. Obtains Legal review and authorizing official signature where necessary.
11. Review daily wholesaler orders and fail to split items. Take action to maximize appropriate splitting from WAC and maximize cost savings through coordination of purchasing with inventory technicians and pharmacy managers. Reviews and approves contracted pharmacy invoices and transactions. Reverse any ineligible claims.
12. Monitors 340B pricing through the wholesalers (Cencora, Cardinal, McKesson)for any pricing discrepancies for retail, hospital, and contracted pharmacies and resolves via wholesaler or manufacturer communication.
13. Tracks expense and revenue for the 340b program for each covered entity and contract pharmacy. Reports on monthly expenses and revenue to System Director of Pharmacy. Optimize savings associates with use of 340b program for eligible transactions and patients. Evaluate contract opportunities for change in formulary or stocked NDC items and penny buys. Evaluate blacklist items annually.
14. Recommend inventory changes to Managers and System Director of Pharmacy monthly. Submit formulary reviews to Clinical Coordinator for P&T Consideration at least annually.
15. Creates and updates inventory technician modules for advance practice competency. Trains and evaluates competency of technicians in this role related to inventory practices during orientation or level 4 inventory training. Provides direct feedback to Technician supervisor related to competency and skills for annual performance evaluations of inventory technicians.
16. Serves as Direct Supervisor for 340b analyst/certified pharmacy technician(s), outsourced support personnel (i.e. Strategic Account Executive from TPA). Provides training, assesses competency, makes duty assignments, conducts check ins and performance evaluations, takes appropriate corrective action per HR policies.
17. Prepares and submits specific data requested from HRSA, auditors, manufacturers, state or federal agencies, legal counsel, or per administrative requests.
18. Oversees the implementation and maintenance of Shelter alternative distribution program for EMH covered entities and contracted pharmacies.
19. Validates accurate ordering processes and record keeping to comply with HRSA regulations and DCSCA(Tracelink).
20. Provides analysis and reports for feasibility of new business opportunities based on historical claims and 340b opportunities.
21. Reviews and acts on discrepancies or non-payment from Beacon MFP platform for misidentified claims. Serves as primary contact for submission of MFP rebate discrepancies.
22. Manages any rebate or medication restriction plan related to the 340b program. Submits claims level data to 340B ESP, Beacon, Kentucky Department of Medicaid Services to ensure consistent access to 340B pricing at entity owned pharmacies, contract pharmacies, and hospital 340B wholesaler accounts and to prevent duplicate discounts.
23. Completes contract pharmacy designations on 340B ESP in accordance with drug manufacturer contract pharmacy policies and restrictions. Evaluates designations and “at risk” pharmacies on an ongoing basis to maintain compliance and optimize net savings.
24. Completes annual HRSA registration of covered entities, child sites and contract pharmacies. Verifies annual eligibility for covered entities with respective Medicare cost reports. Reviews or obtains updated contracts with local, state or federal government officials as required for the 340b program by HRSA. Completes HRSA integrity checks as requested annually.
25. Assists System Director of Pharmacy and System Retail Pharmacy and Ambulatory Care Manager in implementation of new retail pharmacies or new service lines affecting the 340B Program. Completes enrollments with HRSA OPAIs, wholesaler account set up, TPA implementations, 340B accumulator set up, etc.
26. Communicates with pharmacists, pharmacy inventory technicians, retail pharmacy technicians, providers/clinic staff, administrators, legal team, and finance to develop and refine the 340B program integrity, optimization, and maximize 340B savings.
27. Performs monthly audits of 340b transactions for each covered entity and contract pharmacy. Develops action plans to address any gaps in compliance. Takes appropriate action to resolve findings. Reports findings of audits and gap analysis to System Director of Pharmacy monthly and as a quarterly report to Corporate Compliance Committee.
28. Coordinates annual independent audits with consultant group. Submit requested information to consultants in advance of the annual audit. Submit summary of findings and action plan to Corporate Compliance Committee. Take action to resolve issues.
29. Tracks rebates from manufacturers. Maintains file for reporting.
30. Maintains NPI numbers for covered entities and child sites with the Kentucky Medicaid office to prevent duplicate discounts. Verifies that billing of Medicaid claims matches the Medicaid carve out requirements (if any).
31. Processes data requests as a result of a 340b manufacturer audit request. Submits any correspondence for legal review prior to submission. Communicates to Corporate Compliance committee and System Director of Pharmacy.
32. Participates in preparation and actual HRSA OPA 340b program integrity audits. Creates corrective action plan for any findings and submits correspondence for legal review prior to submission.
33. Annually reviews and revises or creates policy and procedures for operation of the 340b program for covered entities and contract pharmacies. Educates Associates on 340b program as it changes.
34. Monitors publications for 340b related news and HRSA/OPA action items. Communicates projected impact on changes to System Director of Pharmacy and Corporate Compliance.
35. Demonstrates a commitment to professional accountability and growth to maintain and expand knowledge and skills.
36. Contributes to the achievement of the mission, vision, and values of the Organization.
37. Contributes to the effective operations of the Organization by demonstrating dependability in job performance.
38. Demonstrates a commitment to incorporating the core concepts of patient family centered care into practice (dignity, respect, information sharing, and participation).
39. Demonstrates a commitment to the development and implementation of shared governance across the Organization.
40. Performs other related duties as assigned.

WORKING CONDITIONS, HAZARDS AND PHYSICAL EFFORT:

Limited office and storage space; small work area. Must be attentive to detail. Stress from deadlines and strict regulations. Some moving of supplies/equipment. May be involved in the preparation and delivery of chemotherapy agents. The task of this job does not involve exposure to blood, body fluids, or tissues, but employment may require performing supplemental tasks that involve exposure to blood, body fluids, or tissues. Must be able to move or position 25 lbs. independently. May work occasional weekends and is eligible for overtime. May be on-call during system testing, down times and Go Live periods. May work remotely for designated assignments as approved by Supervisor.

CONTACTS WITH OTHERS:

In addition to working with other Pharmacy Associates, will interact regularly with nursing Associates, Physicians, Legal team, Finance/Business office, Information Services, Tracelink, Beacon, 340B ESP, Meditech, Cencora, Cardinal, McKesson, and TPA/contract pharmacy support personnel and other clinical and ancillary hospital Associates. Directly supervises 340b analyst/certified pharmacy technicians, outsourced support personnel, pharmacy inventory technicians, and personnel involved in Shelter alternate distribution program or referral or rebate programs.

EQUIPMENT USED/SPECIAL SKILLS REQUIRED:

Working knowledge of wholesaler ordering platform (Cencora) required. Mckesson and Cardinal invoice processing platforms and Split billing software/TPAs (Sentry, Wellpartner, Walgreens, 340B Direct), 340bHealth, referral vendor software (R1/Cloudmed), Tracelink DCSCA software, or Beacon, 340B ESP highly preferred.

Hospital pharmacy experience with IV admixture, code response, kinetic dosing and computer experience highly recommended. Meditech Client Server experience required.