[Hiring] Pharmacy Quality & Compliance Analyst @Firelands Health
Role Description The role of the Pharmacy Quality and Compliance Analyst focuses on, but is not limited to, protecting pharmacy revenue, ensuring reimbursement accuracy, and mitigating compliance risk across the Pharmacy enterprise for Firelands Regional Health System (FRHS) including both hospitals, child Sites and contract Pharmacies.
- Assist with policy and procedure development.
- Conduct compliance through internal self-audits and external audits.
- Maintain split-billing software.
- Provide staff education.
- Oversee inventory practices related to 340B.
Pharmacy Payment & Revenue Integrity
- Work with Ensemble to conduct proactive analysis of pharmacy reimbursement across payer types.
- Assist with evaluating payer contract terms and reimbursement methodologies.
- Identify systemic drivers of reimbursement variance and partner with operational teams to implement corrective actions.
Compliance & Risk Management
- Support compliance with payer, regulatory, and program requirements.
- Serve as a key pharmacy resource for internal audits, external payer audits, and regulatory inquiries.
- Identify compliance risk early and recommend controls to reduce financial exposure and audit findings.
Qualifications
- Strong background in pharmacy operations, reimbursement, and payment integrity.
- Demonstrated experience analyzing pharmacy claims and financial data.
- Advanced understanding of payer methodologies, pharmacy billing workflows, and revenue cycle integration.
- Proven ability to work independently and manage ambiguity.
- High level of comfort presenting findings and recommendations to leadership.
- Familiarity with pharmacy systems and claims platforms (e.g. Pioneer, Meditech).
- Previous experience with the 340B Program.
- Will obtain 340B ACE Certification within 2 years of employment.
- Knowledge of Medical Center pharmacy operations including common practices and policies.
- Excellent personal computer skills with experience using Microsoft Office products.
Requirements
- This role is remote but requires on-site presence during audits and specified business periods.
- Travel to the site at least 4 times a year.
- FHS will reimburse direct travel costs in accordance with current policy.
Benefits
- Competitive pay.
- Excellent benefits.
- Tuition assistance.
- Retirement plan matching.
- Recognition program.
- Local discounts.
Company Description
- Award Winning: Named among the top 10% in the Nation for Patient Safety Excellence Award, America’s 100 Best Orthopedic Surgery, America’s 100 Best Spine Surgery.
- Stability: Serving Erie and surrounding counties since 1876.
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