Pharmacy Business Operations and Compliance Analyst

SHIFT: Day (United States of America)

Children’s Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation. At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care—and your career.

About the Role

The Pharmacy Business Operations and Compliance Analyst supports the Pharmacy Business Operations team across three specialties: 340(b) program, controlled substance monitoring, surveillance, and pharmacy finance/billing compliance. As a member of the Pharmacy Business Operations Team, the analyst collaborates with pharmacy leadership across multiple pharmacy operational areas. Areas of oversight span the entire CHOP enterprise: Philadelphia Hospital campus, King of Prussia Hospital campus, Home Care & Specialty, Retail, and contract pharmacies.

Three primary objectives for each specialty include:

• Operational Compliance Auditing
• Program Maintenance and Optimization
• Data Analysis

Responsibilities

Operational Compliance Auditing

• 340(b) Program:
  • Serve as an institutional compliance resource on 340(b) regarding qualifications, operational processes, contractual agreements, and policies and procedures.
  • Develop and monitor routine monthly and annual reports on 340(b) participation, documenting utilization, savings, problem areas, and exceptions or discrepancies for pharmacy leadership and administration.
  • Perform audits or compliance assessments of specific areas and products to ensure the CDM, charges are passed to accounting, and utilization numbers translate accurately into the report for 340(b) reorders.
  • Audit 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.).
  • Oversee data from multiple sources needed for the surveillance of controlled substance distribution and use processes.
  • Extract data from multiple data sources (e.g., EPIC, Pyxis, Sentri7 Drug Diversion, Dose Edge, RIVA, wholesaler sites, and manual records) to inform, analyze, and report on regular and ad hoc inquiries.
• Finance/Billing:
  • Assist 340B program coordinator with ongoing financial audit of 340B contract pharmacy arrangements to ensure accuracy of invoices and bank statements.
  • Monitor and benchmark performance of 340B contract pharmacy programs and locations.

Program Optimization and Maintenance

• 340(b) Program:
  • Maintain policies and procedures for 340(b) to ensure productivity and efficiency while avoiding unnecessary costs.
  • Maintain the 340B Accumulator (new products, product changes, etc.) to ensure accuracy of the utilization report and efficiency of the charge process.
  • Monitor all outpatient points of service to identify additional qualified areas for 340(b) use.
  • Communicate with staff involved with 340(b) to address problems or suggestions for improvement and establish clear communication channels.
  • Monitor and analyze pharmacy utilization records and 340(b) purchasing accounts to ensure software/tools function accurately.
  • Routinely monitor Office of Pharmacy Affairs (OPA) publications, professional media, and peers to stay updated on interpretations, rulings, and advanced ideas for improving participation.
• Controlled Substances:
  • Partner on monitoring and development of diversion monitoring software to ensure accuracy and continued meeting of program needs.
  • Assist in creating 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 use lean management principles (5S, elimination of waste, JIT, standard work, quality) to ensure a high-reliability culture.
  • Aggregate pharmacy hospital-controlled substance accountability information for internal/external DEA reporting requirements.
  • Compile 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.
  • Collaborate with Nursing and Revenue Integrity to resolve billing questions and discrepancies.
  • Review specific Research and Physician-office invoices and purchase orders with the 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 monitor all areas of 340(b) outpatient use and work with pharmacy purchaser and leadership to ensure maximum participation.
  • Ensure use of 340(b) priced products in all qualified outpatients where available and appropriate.
  • Monitor for 340(b) pricing exclusions or shortages and establish appropriate alternative products, including collaboration with medical staff and formulary.
  • Review 340(b) account records for exceptions and consider alternatives to become standard practice.
  • Participate with prime vendor to review 340(b) formulary pricing, potential alternatives, and possible additional savings.
  • Standardize formularies between areas and institutions to achieve maximum 340(b) participation 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 to identify subjects for potential diversion investigation.
  • Identify and utilize key data resources to detect 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, DEA, CMS, USP797, JCAHO).
• 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.

Qualifications

Education

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

Experience

• At least two (2) years of experience in database management Required
• At least five (5) years of experience 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 healthcare Preferred
• Previous experience in a hospital pharmacy environment including pharmacy operations (340B related experience, controlled substances, finance/billing, etc.) Preferred

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)
• Excellent oral and written communication skills. (Required proficiency)
• Demonstrated ability to document databases, forms, and reports. (Required proficiency)
• Data standards and 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)

Pay

Salary Range: $83,700.00 - $106,700.00 Annually. Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.