Federal Drug Pricing Program Auditor

Federal Drug Pricing Program Auditor

Full Time

Ohio

AndHealth is on a mission to radically improve access and outcomes for the most challenging chronic health conditions, with the goal of making world-class specialty care accessible and affordable to all. We partner with health systems, community health centers and independent specialists to remove barriers to care to ensure all people have access to the care they deserve.

We are looking for a Federal Drug Pricing Program Auditor that will play an important role at AndHealth.

What you'll do in the role:

• Ensure Regulatory Compliance: Maintain strict compliance with Federal Drug Pricing Program and HRSA requirements, continuously monitor program integrity, and advise internal stakeholders on necessary changes based on the HRSA OPAIS website.
• Prevent Fraud and Waste: Ensure all claims are reviewed and processed with the appropriate inventory to prevent diversion and duplicate discounts.
• Conduct Audits and Maintain Records: Perform pharmacy prescription and EHR audits to verify eligibility and collect or track required medical documentation from external providers to maintain complete audit readiness.
• Manage Systems and Data: Utilize and troubleshoot EHR and pharmacy operating systems to build compliant patient profiles and accurately track eligibility and utilization.
• Drive Financial Optimization: Track and analyze monthly savings, variance trends, and purchasing patterns, and generate comprehensive reports for leadership visibility, budget forecasting, and audits.
• Develop Policies and Stay Informed: Create and update program-related policies and procedures and stay current on federal regulations by attending relevant trainings, webinars, and conferences.
• Collaborate with Stakeholders: Establish strong relationships with internal staff and external providers, maintain regular communication to support efficient workflows, and participate in meetings regarding process improvement and quality.
• General Support: Perform other duties as assigned to support the team.

Education & Licensure Requirements:

• High School Diploma required.
• Associate's or Bachelor's degree preferred.
• 340B ACE preferred.

Other Skills or Qualifications:

• Experience with 340B program compliance and operations.
• Ability to proficiently use EHR and pharmacy operating system(s).
• Quality assurance experience, such as medical chart reviews or auditing, is preferred.
• Exceptional organization skills.
• Ability to work independently.
• Strong attention to detail, spelling, and numerical differences.
• Proficient with Excel.
• Exemplary written and verbal communication skills.
• Knowledge of healthcare terminology.

Here's what we'd like to offer you:

• Equal investment and support for our people and patients.
• A fun and ambitious growing environment with a culture that takes on important things, takes risks, and learns quickly.
• The ability to demonstrate creativity, innovation, and conscientiousness, and find joy in working together.
• A team of highly skilled, incredibly kind, and welcoming employees, every one of whom has something unique to offer.
• We know that the overall success of our business is a collaborative effort, and we strive to provide ongoing opportunities for our employees to learn and grow, both personally and professionally.
• Full-time employees are eligible to participate in our benefits package which includes Medical, Dental, Vision Insurance, Paid time off, Short- and Long-Term Disability, 401k match and more.

We are an equal opportunity and affirmative action employer. We embrace diversity and are committed to creating an inclusive environment for all employees. Applicants will be considered for employment without regard to race, religion, gender, gender identity, sexual orientation, national origin, age, disability, or veteran status.