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Summary:
The Corporate Finance 340B Internal Auditor is responsible for surveillance and auditing of pharmacy processes, medication-related activities and applicable software-related transactions across 340B eligible areas within Memorial Healthcare System. Responsible for preparing responses to transaction audits, including audits by finance or payors, drug utilization audits, and review of ineligible 340B claims.
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Detailed responsibilities:
Maintains applicable 340B software integrity, including updates. Reviews applicable reports to identify ineligible claims and areas to improve capture rate.
Integrates applicable information from the pharmacy operating systems and any applicable platform and incorporates such information into auditable and compliant processes.
Responsible for identifying risk areas and analyzing of 340B Policy in day-today 340B pharmacy operations.
Performs pharmacy claim documentation audits to ensure compliance and adherence to established programs, regulations, policies and procedures, and at-risk transactions on a routine basis as established by department lead.
Develops and fosters working relationships with external and internal applicable working counterparts (i.e. nursing, IT, compliance, revenue & reimbursement, Finance, 340B, and others) to provide data and analytics, report issues, mitigate findings, and facilitate productive exchange of information to achieve and sustain compliance.
Develops audit tools for proper identification, reconciliation, and resolution. Escalates any identified issues as they arise during the monitoring, auditing and reconciliation process.
Works with internal and external parties to develop and validate action plans. Follows up on progress and completion of action plans as necessary.
Competencies and skills:
Essential:
STANDARDS OF BEHAVIOR: Acts in a manner that supports the standards of communication, respect, privacy, and teamwork by demonstrating a commitment to professional and ethical conduct.
CUSTOMER SERVICE: Demonstrates commitment to service excellence by promptly addressing internal/external customer issues/requests, resolving concerns while maintaining a professional image and behavior to build and enhance the patient/family/customer experience.
ACCOUNTABILITY: Accepts ownership of job roles and specific assignments/goals; works independently, takes responsibility for own actions; admits mistakes and judgment errors; and accepts constructive feedback. Connects personal work results to the accomplishment of team and organizational goals.
RESPONDING TO CHANGE: Accepts change and adapts in a positive and productive manner; handles unexpected situations and changes in direction calmly and with confidence. Views new assignments and job responsibilities as an opportunity for growth.
ANALYSIS AND DECISION MAKING: Uses decision making processes and tools to analyze situations and make effective decisions.
DEVELOPING RELATIONSHIPS: Builds positive and productive business relationships with individuals and groups.
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Education:
Essential:
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Credentials:
Education equivalent experience:
Essential:
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Other information:
Complexity of Work: Requires initiative, critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work demonstrate a resilient and can do attitude. Be able to respond to change positively.
Required Work Experience: Five (5) years of experience in a pharmacy setting, hospital administration, finance, and or related field.
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Working conditions:
Essential:
Bending and Stooping ; ; ; 80.00%
Climbing ; ; ; 60.00%
Keyboard Entry ; ; ; 80.00%
Kneeling ; ; ; 60.00%
Lifting or Carrying 0 – 25 lbs Non-Patient ; ; ; 80.00%
Lifting or Carrying 25.01 lbs – 75 lbs Non-Patient ; ; ; 80.00%
Pushing or Pulling 0 – 25 lbs Non-Patient ; ; ; 80.00%
Pushing or Pulling 26 – 75 lbs Non-Patient ; ; ; 80.00%
Reaching ; ; ; 80.00%
Repetitive Movement Hand/Arm ; ; ; 80.00%
Running ; ; ; 40.00%
Sitting ; ; ; 80.00%
Squatting ; ; ; 60.00%
Standing ; ; ; 80.00%
Walking ; ; ; 80.00%
Audible Speech ; ; ; 80.00%
Hearing Acuity ; ; ; 80.00%
Depth Perception ; ; ; 80.00%
Distinguish Color ; ; ; 80.00%
Seeing – Far ; ; ; 80.00%
Seeing – Near ; ; ; 80.00%
Bio hazardous Waste ; ; ; 40.00%
Biological Hazards – Respiratory ; ; ; 40.00%
Biological Hazards – Skin or Ingestion ; ; ; 40.00%
Communicable Diseases and/or Pathogens ; ; ; 40.00%
Cytotoxic Chemicals ; ; ; 60.00%
Dust ; ; ; 60.00%
Gas/Vapors/Fumes ; ; ; 60.00%
Hazardous Medication ; ; ; 60.00%
Latex ; ; ; 40.00%
Computer Monitor ; ; ; 80.00%
Domestic Animals ; ; ; 40.00%
Fire Risk ; ; ; 40.00%
Moving Mechanical Parts ; ; ; 80.00%
Needles/Sharp Objects ; ; ; 80.00%
Potential Electric Shock ; ; ; 40.00%
Potential for Physical Assault ; ; ; 40.00%
Radiation ; ; ; 60.00%
Wet or Slippery Surfaces ; ; ; 60.00%
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Organizational Profile:
Since its inception in 1953, Memorial Healthcare System has been a leader in providing high-quality healthcare services to South Florida residents. Today, it is one of the largest public healthcare systems in the nation with over 13,000 team members and highly regarded for its exceptional patient- and family-centered care. Memorial’s patient, physician and employee satisfaction rates are some of the most admired in the country, and the system is recognized as a national leader in quality healthcare.
Memorial has a reputation as one of Florida’s leading healthcare systems and is supported by a distinguished medical staff. In fact, the vast majority of physicians are board certified or board qualified in their specialties and have been trained at many of the nation’s finest medical schools and hospitals. Because of its distinguished medical staff and services, Memorial draws patients from South Florida and beyond.
Many prestigious healthcare awards have been earned by Memorial Healthcare System and its facilities. The accolades include: Modern Healthcare magazine’s Best Places to Work in Healthcare, Florida Trend magazine’s Best Companies to Work for in Florida, 100 Top Hospitals, Consumer Choice Award, Best-Run Hospital, Best Nursing Staff, Best Pediatric Hospital and Best Maternity Hospital.
Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.
Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.
Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.
We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.
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