Pharmacy Quality & Compliance Analyst: Sal

🌍 Remote, USA 🎯 Full-time 🕐 Posted Recently

Job Description

About the position

The role of the Pharmacy Quality and Compliance Analyst focuses on, but is not limited to, protecting pharmacy revenue, ensuring reimbursement accuracy, and mitigating compliance risk (accreditation bodies, state boards, payers, etc.) across the Pharmacy enterprise for Firelands Regional Health System (FRHS) including both hospitals, child Sites and contract Pharmacies. This role also includes assisting, at the direction of, the Director of Pharmacy and/or Pharmacy Expansion and 340B Program Compliance Coordinator with policy and procedure development, compliance through internal self-audits and external audits, maintenance of the split-billing software, staff education, and oversight of inventory practices related to 340B.

Pharmacy Payment & Revenue Integrity Work with Ensemble to conduct proactive analysis of pharmacy reimbursement across payer types to identify underpayments, overpayments, billing errors, and process gaps
Assist with evaluating payer contract terms and reimbursement methodologies to ensure pharmacy services are reimbursed as intended
Identify systemic drivers of reimbursement variance and partner with operational teams to implement corrective actions; including specialty pharmacy services
Compliance & Risk Management Support compliance with payer, regulatory, and program requirements, including Medicare, Medicaid, and 340B
Serve as a key pharmacy resource for internal audits, external payer audits, and regulatory inquiries
Identify compliance risk early and recommend controls to reduce financial exposure and audit findings

While this role is remote, the expectation is that this person will be on-site for the entire duration of the audits and for a prespecified time period for other business as deemed necessary by the Director of Pharmacy. This could mean traveling to the site at least 4x/year. FHS will reimburse direct travel costs in accordance with current policy.
Strong background in pharmacy operations, reimbursement, and payment integrity, ideally within a hospital or health system environment
Demonstrated experience analyzing pharmacy claims and financial data to identify risk, opportunity, and root cause
Advanced understanding of payer methodologies, pharmacy billing workflows, and revenue cycle integration
Proven ability to work independently, manage ambiguity, and influence outcomes across departments
High level of comfort presenting findings and recommendations to leadership
Familiarity with pharmacy systems and claims platforms (e.g. Pioneer, Meditech)
Knowledge of Medical Center pharmacy operations including common practices and policies and procedures.
Excellent personal computer skills with experience using Microsoft Office products including Outlook, Excel, and Word.

Previous experience with the 340B Program.
Will obtain 340B ACE Certification within 2 years of employment in this position Cost of exam will be paid for by FHS upon successful completion (unsuccessful attempts & studying material will not be reimbursed)