Medicaid Program Integrity Jobs in Ohio (NOW HIRING)

Join our team as a Pharmacy Compliance Auditor - 340B Program and play a vital role in ensuring access to affordable medications for underserved communities. In this position, you will help safeguard the integrity of the 340B Drug Pricing Program-a federal initiative that enables healthcare organizations to stretch resources and provide comprehensive care to more patients. As a Pharmacy Compliance Auditor, you'll work closely with pharmacy leadership to conduct audits, monitor compliance, and identify opportunities for improvement.

This role offers the chance to develop specialized expertise in 340B operations, gain advanced certifications, and make a meaningful impact on patient care and organizational success. If you are detail-oriented, passionate about compliance, and eager to grow in a critical area of pharmacy operations, we'd love to hear from you. Location: Norwood, OH Work Hours: Full Time, 80 hours biweekly Day shift No weekends, or holidays commitment Incentives & Benefits: We offer a comprehensive benefits package, including medical, dental, vision, paid time off, retirement plans, and tuition reimbursement.

For more information, please visit our benefits page: https://careers.trihealth.com/what-we-offer/benefits Minimum Job requirements: High School Diploma or GED (required) Minimum of 2-3 years of experience in one or more of the following areas (required): Technical Pharmacy Hospital Pharmacy Pharmacy purchasing 340B program administration Ability to successfully complete Apexus 340B University within six (6) months of hire (required) Ability to successfully earn the 340B Operations Certificate within one (1) year of hire (required) National Pharmacy Technician Certification (CPhT) is required. Accepted certifications include: Pharmacy Technician Certification Board (PTCB) ExCPT Certification through the National Healthcareer Association (NHA) Must be currently registered as a Certified Pharmacy Technician with the Ohio Board of Pharmacy (required) Job Overview: The Pharmacy Compliance Auditor works under the supervision of the Sr. Director of Pharmacy and guidance of the 340B Pharmacy Compliance Coordinator to audit and monitor the 340B Program

Functions will include, but not limited to execution and documentation of daily, weekly, monthly, and quarterly audits to verify adherence with the 340B Program regulations and/or guidelines and as outlined in 340B policies and procedures. The 340B Drug Pricing Program is a US Federal program that requires drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices. The intent of the program is to allow covered entities to stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.

Job Responsibilities: Accurately and efficiently performs 340B audits on a scheduled basis, including contract pharmacy, mixed use pharmacy, and outpatient pharmacy, and ensures compliance to the 340B Program. Addresses any reconciliations that arise. Monitors and audits state Medicaid claims.

Uses Excel, to filter out non-eligible transactions. Evaluates patient eligibility for qualified and non-qualified patients in mixed-use areas and clinics. Maintains and audits the Prescriber file provided by Medical Staffing Office.

Assists with external audits, as assigned. Maintains easily retrievable copies of audits and reports for compliance and audit purposes. Review's findings, issues, and steps taken to reconcile the issue with the Pharmacy Compliance Coordinator.

Ensures that reporting meets organizational, regional, national, state, and federal requirements/guidelines. Routinely monitors industry publications and websites, and that organization has latest updates and information. Signs up for 340b webinars.

Audits Contract Pharmacy matches and analyzes the causes of incorrect accumulations and reverses incorrect matches. Identifies and accumulates eligible matches from suspects. Maintains auditable records of purchases sent to Contract Pharmacies and payments made to the Covered Entity.

Audits Outpatient Pharmacy matches and analyzes the causes of incorrect accumulations and reverses incorrect matches. Audits whether correct pricing plan was applied to Medicaid/Managed Medicaid. Audits the sub-clarification code 20 application to all FFS and MCO Medicaid claims, as well as verifying that the 08 code was applied.

Identifies and accumulates eligible matches from suspects. Responsible for loan-borrow tracking. Maintains auditable records and facilitates inventory reconciliations.

Compiles purchasing information, such a list of TriHealth purchasing accounts. Provides the Pharmacy Buyers with information needed to place orders using the appropriate accounts to replenish inventory in the mixed-use inventory setting. Verifies data integrity within 340B software and wholesaler/vendor purchase reports to after corrections and rebills are made and approves the order review in the queue.

Provides root cause analysis and corrections of NDCs. Identifies and submits Individual wastes. Other Job-Related Information: Healthcare system knowledge base/skills Proficiency in Microsoft Office software, specifically Excel, Word, and Outlook Ability to quickly learn technical systems such as EMR systems, retail pharmacy systems, and/or 340B software systems Ability to work in a complex team environment and to collaborate with peers to complete required work Strong interest in pharmacy practice advancement Excellent verbal and written communication skills; communication style that is open and fosters trust, credibility and understanding.

Working Conditions: Climbing - Rarely Concentrating - Consistently Continuous Learning - Consistently Hearing: Conversation - Frequently Interpersonal Communication - Consistently Kneeling - Rarely Lifting <10 Lbs. - Rarely Lifting 50+ Lbs. - Rarely Lifting 11-50 Lbs.

- Rarely Pulling - Rarely Pushing - Rarely Reaching - Rarely Reading - Consistently Sitting - Consistently Standing - Occasionally Stooping - Rarely Thinking/Reasoning - Consistently Use of Hands - Occasionally Color Vision - Consistently Walking - Occasionally TriHealth SERVE Standards and ALWAYS Behaviors At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following: Serve: ALWAYS... Welcome everyone by making eye contact, greeting with a smile, and saying "hello" Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist Refrain from using cell phones for personal reasons in public spaces or patient care areas Excel: ALWAYS..

Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met Offer patients and guests priority when waiting (lines, elevators) Work on improving quality, safety, and service Respect: ALWAYS... Respect cultural and spiritual differences and honor individual preferences. Respect everyone's opinion and contribution, regardless of title/role

Speak positively about my team members and other departments in front of patients and guests. Value: ALWAYS... Value the time of others by striving to be on time, prepared and actively participating

Pick up trash, ensuring the physical environment is clean and safe. Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste. Engage: ALWAYS..

Acknowledge wins and frequently thank team members and others for contributions. Job keywords: Accredited Pharmacy Technician, Certified Pharmacy Technician (CPhT), Chemotherapy Pharmacy Technician (Chemo Pharmacy Technician), Compounding Technician, OR Pharmacy Tech (Operating Room Pharmacy Tech), RPhT (Registered Pharmacy Technician) Apply Apply (Existing Employee)