Pharmacy Analyst at Catholic Health in Centereach, NY

Job description

Overview Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time. We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace! Job Details The Pharmacy Analyst is responsible for reviewing and processing medication prior authorization (PA) requests from healthcare providers, patients, and insurance companies. This role involves communicating with medical professionals, insurance representatives, and patients to ensure the timely and accurate approval of prescriptions. The technician ensures that all necessary documentation is in place for approvals and works to resolve any issues related to denied or pending requests. This analyst also plays a crucial role in ensuring compliance with the 340B Drug Pricing Program (340B Program), which allows eligible healthcare organizations to purchase medications at discounted prices. This position involves analyzing 340B program data, ensuring correct implementation of 340B program requirements, performing audits, generating reports, and assisting with regulatory compliance activities. The analyst works closely with pharmacy, finance, compliance, and legal teams to support the organization's participation in the 340B program. Key Responsibilities: Process Prior Authorization Requests: Review, validate, and process prior authorization (PA) requests for prescribed medications based on the patient's insurance coverage. Collaborate with Healthcare Providers: Contact physicians or other healthcare professionals to obtain additional documentation or clarification for PA requests as needed. Communicate with Insurance Companies: Liaise with insurance providers to track the status of PA requests and resolve any issues or delays in approvals. Documentation Management: Maintain accurate records of all prior authorization requests, approvals, denials, and outcomes for compliance and reporting purposes. Patient Support: Assist patients in understanding the prior authorization process and any necessary steps they may need to take. Provide updates on the status of their PA requests. Follow Up: Monitor ongoing PA requests and follow up on outstanding approvals or denials to ensure timely resolution. Maintain Compliance: Ensure that all processes are compliant with company policies, healthcare regulations, and insurance requirements. Assist with Medication Therapy Management (MTM): Provide support in medication therapy management programs when applicable, ensuring patients receive the appropriate medications as authorized. Monitor 340B Program Compliance: Regularly review and analyze 340B program activities to ensure adherence to all applicable federal, state, and institutional regulations and policies. Data Analysis and Reporting: Collect, analyze, and interpret data related to drug purchasing, inventory, and dispensing to generate accurate and timely 340B reports for internal and external stakeholders. Auditing and Reconciliation: Perform regular audits of 340B transactions, including comparing purchased versus dispensed drugs, ensuring that all transactions are properly documented and compliant with program requirements. Reconcile discrepancies and take corrective actions when needed. Assist with 340B Program Enrollment: Support the organization's initial and ongoing enrollment in the 340B program, including submitting necessary documentation and assisting with audits from federal regulators. Policy and Procedure Development: Assist in the development and implementation of policies an