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Compliance Specialist
$88k-113k (estimate)
Full Time
1 Week Ago
Promise Healthcare is Hiring a Compliance Specialist Near Champaign, IL
DUTIES AND RESPONSIBILITIES:
340B Program General Duties -
MINIMUM QUALIFICATIONS - To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
340B Program General Duties -
- Serves as PHC's compliance expert on 340B Program details, policies, and procedures.
- Acts as the liaison with necessary affiliated departments to ensure 340B Program integrity.
- Provides expertise with the 340B Program to staff and participants regarding ongoing compliance. This includes providing ongoing training, regulation or policy changes, and other communication required for the 340B program for PHC staff.
- Develops and maintains internal relationships and external relationships with contract pharmacies, vendors, etc., as needed.
- Participates in decision-making processes related to the implementation of new 340B processes. Responsible for annual HRSA recertification and making sure all HRSA OPAIS information is accurate and up to date for all PHC entities.
- Ensures that policies and procedures are developed, implemented, and maintained according to organizational, regional, national, state, and federal requirements and guidelines.
- Establishes consistent policies and procedures for 340B that ensure productivity and efficiency so that long-term management of the program does not hamper operations or create unnecessary costs.
- Monitors and assesses 340B guidance and/or rule changes, including, but not limited to HRSA/OPA rules and Medicaid changes. Attends regular 340B trainings and shares lessons and hot topics with CMO/clinical providers.
- Routinely monitors industry publications and websites as well as the professional media, literature, and peers to ensure that the institution has the latest information regarding interpretations, rulings, suggestions, and advanced ideas for improving participation.
- Ensures that the 340B pharmacy program is continuously compliant with 340B federal regulations.
- Develops, executes, and documents self-audits of the 340B process. Coordinates and ensures remediation of findings.
- Oversees, coordinates, and serves as point person for the annual independent compliance audit of 340b. Documents results and follow-up on any findings. Maintains a current state of "audit readiness."
- Ensures that audits follow current regulatory compliance recommendations and are completed at the site level.
- Reviews and monitors all points of service where 340B participation occurs to ensure policy and procedure compliance, covered entity eligibility, and "covered patient" eligibility.
- Responsible for managing and troubleshooting pharmacy billing issues and ensuring that adequate systems checks are reviewed to prevent billing issues.
- Works with Finance department to monitor utilization records and 340B purchasing accounts to ensure that software or tools are working properly and accurately, performing audits or compliance assessments internally as needed; coordinates external compliance assessments with outside firms, when appropriate, to validate internal processes.
- Monitors 340B compliance within workflow processes.
- Responsible for the day-to-day management, compliance review, and operations of clinic- administered medications in eligible locations, and outpatient prescriptions fulfilled by a contract 340B pharmacy.
- Ensures evaluations are completed for gaps at the site level and assists in providing the tools necessary to be compliant with the 340B Program.
- Evaluates covered entity compliance at the contract pharmacy, covered entity, and wholesaler levels.
- Performs 340B purchasing and utilization audits or compliance assessments internally, as needed.
- Manages relationships, billing services, and compliance with contracted 340B pharmacies.
- Assesses opportunities for cost savings and business improvements in 340B contract pharmacy utilization.
- Assesses opportunities for cost savings and system improvements to yield higher compliance.
- Oversees the 340B contract pharmacy marketing program to attract and retain qualified retail pharmacy contracts and serve eligible patients.
- Analyzes utilization of the program and existing software to identify ways to compliantly use the 340B Program to its fullest extent to meet the needs of underserved patients.
- Works directly with manufacturers as well as wholesalers to develop strategies for appropriate use of the program.
- Develops action plans to close identified gaps in collaboration with organizational leadership.
- Provides oversight for the implementation of process improvement initiatives and creates an environment that places an emphasis on continuous monitoring and improvement.
- Routinely monitors monthly and annual reports on 340B participation that clearly document utilization, savings, problem areas, and exceptions or discrepancies, to be passed on to Compliance Manager and other leadership and administration.
- Coordinates with finance department for monthly financial reporting and analysis, including, but not limited to, metric reporting, scorecards, and variance analysis and reporting.
- Ensures that reporting meets organizational, regional, national, state, and federal requirements/guidelines.
- Routinely communicates any questions, issues, or discrepancies with the appropriate authority.
- Ensures appropriate documentation, records, and audit trail across areas of responsibility.
- In collaboration with Medical Services Director, manages and tracks 340B onsite drug inventory (including proper replenishment of inventory) and review of 340b purchase orders Ensures compliance with regulations related to 340B purchasing.
- Routinely monitors utilization records and 340B purchasing accounts to ensure that software or tools are working properly.
- Receives, acknowledges, and assesses all new claims that may arise against PHC.
- Identifies and arranges for the preservation of relevant records.
- Establishes and maintains contact and support to relevant current and former staff, as necessary especially for any requirement for witness statements, court appearances etc.
- Refers to and liaises with FTCA and/or PHC insurers as appropriate.
- Systematically reviews case files to ensure that claims are progressed and concluded as soon as possible, via the appropriate authorities.
- Ensures that information emerging during claims investigations and the outcome is shared with staff directly involved in the case, including clinicians, directors, senior managers, and the Board of Directors via quality and risk management meetings.
- Prepares reports and other submissions for relevant clinical and non-clinical claims, and for FTCA and/or PHC insurers if required. Manages the credentialing and privileging process at PHC for providers and clinical support staff.
- Ensure all credentialing and privileging documentation is up to date.
- Participates in risk management activities in conjecture with supervisor.
- Contributes positively to educational programs for the benefit of front line clinical and ancillary staff.
- Helps ensure that policies and procedures are developed, implemented, and maintained according to organizational, regional, national, state, and federal requirements and guidelines.
MINIMUM QUALIFICATIONS - To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
- Possess excellent interpersonal and administrative management experience.
- Requires a high level of computer skills and excellent proficiency in MS Office, including but not limited to Outlook, Word, Excel, and Power Point.
- Must have a positive attitude, demonstrate initiative and professionalism.
- Requires exceptional organizational skills, the ability to multi-task with strong attention to detail, with significant experience effectively managing the time of self and others.
- Ability to maintain confidentiality is essential.
- Must exhibit cultural sensitivity and be accustomed to and comfortable with working in an inclusive and diverse environment.
- Demonstrate expert level communication (written and verbal) skills.
- Possess excellent critical thinking ability, using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
- Must possess initiative, flexibility, and the ability to effectively collaborate.
- Must be team player but can also work on own initiatives independently.
- Ability to positively interact with staff and external partners (at all levels) in a fast-paced environment, sometimes under pressure.
- Ability to managing multiple, simultaneous, and occasionally complex projects to achieve desired results.
- Master's degree in business, IT, healthcare, science, or related field. Advanced pharmacy degree preferred.
- Requires three to five years of administrative support experience and a minimum of two years of experience in a senior level administrative support role managing multiple assignments.
- Must have 340B knowledge and/or experience.
- Requires 340B Certificate or attainment within first 9 months of hire.
- Experience with FQHCs highly preferred.
- Must be self-directed.
Job Summary
JOB TYPE
Full Time
SALARY
$88k-113k (estimate)
POST DATE
05/06/2024
EXPIRATION DATE
05/19/2024
WEBSITE
promisehealthcare.com
HEADQUARTERS
BOCA RATON, FL
SIZE
3,000 - 7,500
FOUNDED
2014
CEO
PETER R BARONOFF
REVENUE
$200M - $500M
INDUSTRY
Business Services
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The following is the career advancement route for Compliance Specialist positions, which can be used as a reference in future career path planning. As a Compliance Specialist, it can be promoted into senior positions as a Compliance Specialist IV that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Compliance Specialist. You can explore the career advancement for a Compliance Specialist below and select your interested title to get hiring information.
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