Pharmacy Business Operations and Compliance Analyst

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A Brief Overview

The Pharmacy Business Operations and Compliance Analyst supports the Pharmacy Business Operations team across 3 different specialties: 340(b) program, controlled substance monitoring, surveillance, and pharmacy
finance/billing compliance.

As a member of the Pharmacy Business Operations Team, the Pharmacy Business Operations and Compliance Analyst collaborates with pharmacy leadership across multiple pharmacy operational areas. Areas of oversight
and involvement span the entire CHOP enterprise: Philadelphia Hospital campus, King of Prussia Hospital campus, Home Care & Specialty, Retail, and contract pharmacies.

Three primary objectives or goals for each specialty include:
* Operational Compliance Auditing
* Program Maintenance and Optimization
* Data Analysis

The Pharmacy Business Operations and Compliance Analyst is responsible for compiling and monitoring financial and compliance metrics and for leveraging data to ensure compliance and optimization of Pharmacy Business
Operations programs.

What you will do

• Operational Compliance Auditing
• 340(b) Program:
• Serve as an institutional compliance resource on 340(b) regarding qualifications to the details, operational processes, contractual agreements, and policies and procedures.
• Develops and monitors routinely monthly and annual reports on 340(b) participation which clearly documents
  utilization, savings, problem areas and exceptions or discrepancies, to be passed to pharmacy leadership and administration
• Performs audits or compliance assessments of specific areas and specific products to ensure the CDM, the charges are passes to accounting and that the utilization numbers are translating accurately into the report
  for 340(b) reorders
• Audits target issues of 340B diversion, GPO prohibition, and Duplicate Discount violations
• Controlled Substance:
• Ongoing evaluation and completion of assigned task list (daily, weekly, monthly, etc.)
• Responsible for overseeing data from multiple sources needed for the surveillance of controlled substance distribution and use processes.
• Extract data from multiple data sources, as needed, to inform, analyze, and report on regular and ad hoc inquiries.
• Relevant sources/systems include: EPIC, Pyxis, Sentri7 Drug Diversion, Dose Edge, RIVA, wholesaler sites, and manual records
• Finance/Billing:
• Assist 340B program coordinator with ongoing financial audit of 340B contract pharmacy arrangements to ensure accuracy of invoices and bank statements.
• Monitors and benchmarks performance of 340B contract pharmacy programs and locations.
• Program Optimization and Maintenance
• 340(b) Program:
• Maintains policies and procedures for 340(b) that ensure productivity and efficiency while ensuring program management does not hamper operations and/or create unnecessary costs.
• Maintains the 340B Accumulator (new products, product changes, etc.) to insure both the accuracy of the utilization report and the efficiency and accuracy of the charge process
• Monitors all outpatient points of service to continually look for additional qualified areas where 340(b) may be used.
• Communicates with all staff involved with 340(b) to ensure processes remain efficient and to address any problems or suggestions for improvement; also establishing a clear way for them to communicate to the coordinator any concerns or problems at any time
• Monitors routinely and analyzes pharmacy utilization records, 340(b) purchasing accounts to ensure software or tools are working properly and accurately
• Routinely monitor Office of Pharmacy Affairs (OPA) publications and websites as well as the professional media, literature, and peers to assure the institution has the latest information regarding interpretations, rulings, suggestions, and advanced ideas for improving participation
• Controlled Substances
• Partners on monitoring and development of diversion monitoring software to ensure accuracy and continued meeting of program needs.
• Assist in the creation of metrics for compliance, performance, and quality goals pertaining to controlled substance usage
• Develop methods to track, trend, and display historical data over time
• Promote and uses lean management principles as the department's "primary tool for ensuring a mindful, high reliability culture" (5S, elimination of waste, JIT, standard work, quality, promote and comply with standardized procedures/work, identify "waste" in ownership process and recommend solutions for implementation, correction abnormal condition
• Responsible for aggregating pharmacy hospital-controlled substance accountability information for internal/external DEA reporting requirements.
• Compiles data and reporting requirements for DEA biennial controlled substance inventory
• Finance/Billing:
• Maintain multiple EPIC work-queues involving bulk charges, high-cost drugs, consignment medications, JW modifiers, etc. to ensure proper billing.
• Collaborates with Nursing and Revenue Integrity to resolve billing questions and discrepancies.
• Review specific Research and Physician-office invoices and purchase orders with purchasing team to generate proper charges
• Complete review of monthly wholesaler Pre-Pay report and share with Pharmacy Directors for approval.
• Data Analysis
• 340(b) Program:
• Routinely monitors all areas of 340(b) outpatient use and works with pharmacy purchaser and pharmacy leadership to ensure maximum participation regarding:
• Ensure use of 340(b) priced products in all qualified outpatients where available and appropriate therapeutic or generic choice
• Monitors for 340(b) pricing exclusions or shortages and establish appropriate alternatives products that are included where possible, including work with medical staff and formulary to assure proper position and related use
• Reviews 340(b) account records for exceptions, drugs required to be purchased at WAC, etc., then consider possible alternatives to become standard practice
• Participates with prime vendor and reviews routinely 340(b) formulary pricing, potential alternatives, and possible additional savings as a result of GPO formulary
• Standardizes formularies between areas and institutions to achieve maximum 340(b) participating and savings
• Controlled Substances
• Analyze controlled substance data pertaining to anesthesia, nursing, and pharmacy processes for potential drug diversion.
• Produce process-based reports from multiple data sources that identify subjects for potential diversion investigation.
• Identifies and utilizes key data resources as required to identify potential significant loss or theft of controlled substances.
• Provide data and analysis to ensure pharmacy department meets all legal, accreditation, and certification requirements: FDA, Board of Pharmacy, Board of Health, DEA, CMS, USP797 and JCAHO relating to the prescribing, distribution, dispensing, preparation, storage, administration, and disposal of controlled
  substances
• Finance/Billing:
• Perform analysis of wholesaler pre-pay invoices to ensure reconciliation of multiple data sources and report final results to management
• Assess EPIC charge on administration data and provide results to nurse managers to ensure medication accountability and identify missing revenue opportunities

Education Qualifications

• Bachelor's Degree Required
• Bachelor's Degree with clinical informatics, sciences, math, statistics, healthcare management or other healthcare related degree Preferred
• Bachelor's Degree Accounting, Business, Information Systems, or related field Preferred

Experience Qualifications

• At least two (2) years of experience in database management Required
• At least five (5) years of experience in in database management Preferred
• Previous experience in a healthcare setting Preferred
• At least three (3) years of experience in internal audit, public accounting, or
  commensurate health care Preferred
• Previous experience in a hospital pharmacy environment including
  pharmacy operations (340B related experience, controlled
  substances, finance/billing, etc.)

Skills and Abilities

• Working knowledge of relational database query and reporting, especially complex SQL development. (Required proficiency)
• Familiarity with basic statistical packages (i.e., SAS, SPSS, etc) (Required proficiency)
• Ability to generate descriptive statistics, and experience in verifying, documenting, and cleaning large data files. (Required proficiency)
• Electronic Data Capture form design and development including web-based trial management systems and Microsoft Access (Required proficiency)
• Experience in user support (Required proficiency)
• Working knowledge of project management and business processes and/or basic elements of research design. (Required proficiency)
• Must exhibit excellent oral and written communication skills. (Required proficiency)
• Demonstrated ability to document databases, forms, and reports (Required proficiency)
• Data standards, coding conventions. (Required proficiency)
• Knowledge of MS Word and Excel. (Required proficiency)
• Knowledge of grant preparation, rules and processes. (Required proficiency)
• Knowledge of Statistics. (Required proficiency)
• Ability to implement and utilize new and existing software applications. (Required proficiency)
• Ability to handle multiple tasks. (Required proficiency)
• Knowledge of medical terminology. (Required proficiency)
• Ability to handle confidential materials and matters. (Required proficiency)
• Strong organizational skills. (Required proficiency)

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must receive an annual influenza vaccine. Learn more.

EEO / VEVRAA Federal Contractor | Tobacco Statement

SALARY RANGE:

Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.

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At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOP's Compensation and Benefits.