Position Summary

Under the direction of the Director of Finance, performs basic functions of the 340B program including the day to day management, compliance review, and operations of the 340B program including; clinic administered medications in eligible locations, outpatient prescriptions filled by a contract 340B Pharmacy, capture 340B referral claims by "closing the loop" on the referral process.

Position Accountabilities

Responsible for partnering with covered entities to identify and capture 340B referral claims by "closing the loop" on the referral process.

Direct communication with Covered Entities and other Physician offices to gather the needed information.

Identify eligible claims using covered entity's requirements.

Gather and store documentation in EHR to support eligibility.

Working inside TPA software to mark claims as 340B eligible.

Be involved in any and all 340B Program audits.

Perform audits on a scheduled basis; may involve presenting and resolving reconciliation issues as they arise during the monitoring and reconciliation process.

Ensure compliance with 340B Program requirements for qualified patients, drugs, and locations.

Monitor and audit state Medicaid claims to ensure compliance to prevent potential duplicate discount rebates.

Using Excel or a comparable data management program, filter out non-eligible transactions, including, but not limited to, drugs used to treat patients during inpatient care, Medicaid patients, drugs provided free by manufacturers, those provided at non-eligible locations, or prescriptions written by non-eligible providers.

Evaluate patient eligibility for qualified and non-qualified patients in mixed-use areas and clinics by reviewing patient medical records, insurance plans, and, if applicable, hospital status.

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

Evaluate and communicate cost savings opportunities.

Work with supervisor to develop and maintain reports that can be used to educate staff and assist management in tracking the overall financial impact to the organization. Build other reports, as appropriate, to monitor and improve 340B Program compliance and performance.

Maintain copies of reports for compliance and audit purposes.

Update 340B Program reporting packages detailing volume, financial value, and other reporting metrics as needed.

Use provided tools to monitor prescription data, patient data, hospital data, payer data, site of care, and, if required, ICD-10 codes. Summarize and report results to the appropriate individuals.

Monitor, report, and analyze contract pharmacy 340B activities; provide financial reports covered entities relative to financial impact and liabilities; make recommendations that would improve efficiency.

Perform covered entity-specific gross financial analysis and make recommendations to improve program performance. Track financial impact over time, identify root causes of adverse trends, and make recommendations to improve the program’s financial stability.

Review and refine monthly 340B cost savings reports detailing purchasing and replacement practices, as well as dispensing patterns.

Develop a thorough understanding of the split-billing/third party administrator systems and the functions to be performed.

Will adhere to established safety practices and standards.

Perform other related duties as assigned.

Job Type: Full-time

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Education:

• High school or equivalent (Required)

Experience:

• Medical Assistant: 1 year (Preferred)
• Pharmacy technician: 1 year (Preferred)

Work Location: Hybrid remote in Lordsburg, NM 88045

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