Pharmacy Compliance Specialist

At Virginia Garcia Memorial Health Center, we honor all members of our community and acknowledge the dignity of each person we serve. Our purpose is to provide high quality, comprehensive primary health care to the communities of Washington and Yamhill counties with a special emphasis on migrant and seasonal farm workers and a view to removing barriers to health care. We strive to provide an environment that welcomes and values the people we employ and serve. If you are unsure whether you meet all the required qualifications for this role but are interested and passionate about this potential position, we encourage you to apply. Job Summary: Virginia Garcia’s pharmacies serve eligible patients through the 340B drug pricing program and operate under Oregon Board of Pharmacy requirements. Reporting to the Pharmacy Director, the Pharmacy Compliance Specialist is responsible for 340B compliance, Oregon Board of Pharmacy regulatory compliance, pharmacy contract administration, pharmacy staff credentialing, and insurance payment reconciliation across VG’s six pharmacies. The position brings in-house work that has been handled by outside vendors and is cross-trained to back up the Pharmacy Operations Department Administrator, including Epic Willow technical support.

Essential Duties and Responsibilities:

Pharmacy Compliance Specialist General Duties:

• Serves as an internal resource on 340B Program requirements, Oregon Board of Pharmacy requirements, and related VG policies and procedures.
• Acts as the liaison with affiliated departments (accounting, billing, compliance, credentialing, EHR, human resources) to support 340B Program integrity and pharmacy regulatory compliance.
• Supports the Pharmacy Director’s oversight of pharmacy compliance and participates in the organization’s 340B oversight committee as directed.
• Coordinates with external compliance vendors and consultants, and takes on work they currently perform as internal capacity is built.
• Provides compliance guidance to pharmacy managers and pharmacy staff at each site.

340B Compliance:

• Is responsible for ensuring that the annual HRSA recertification, the accuracy of the HRSA 340B OPAIS record for all organization entities, and the registration of any new associated sites are completed within the allowable time frames, in coordination with the Pharmacy Director.
• Develops, executes, and documents self-audits of 340B processes at owned pharmacies, clinic-administered medication locations, and contract pharmacies. Coordinates and ensures remediation of findings.
• Regularly reviews 340B-eligible locations to verify adherence to program policies, covered entity eligibility, and “covered patient” eligibility.
• Monitors utilization records and 340B purchasing accounts, and works with the 340B third-party administrator to confirm that reports and software are accurate.
• Investigates and resolves 340B billing and eligibility discrepancies, and recommends system checks to prevent recurrence.
• Serves as the point person for external audits: coordinates requests and responses, and maintains a current state of “audit readiness.”

Oregon Board of Pharmacy Compliance:

• Monitors Oregon Board of Pharmacy laws and rules that affect VG pharmacies and communicates changes to pharmacy leadership.
• Tracks pharmacy license and registration renewals for each pharmacy and ensures they are completed on time.
• Supports inspection readiness at each pharmacy by coordinating self-inspections, documentation, and follow-up on corrective actions.
• Supports the development, review, and maintenance of pharmacy policies and procedures in collaboration with the Pharmacy Director.

Contract Administration:

• Maintains pharmacy contracts and agreements (including 340B contract pharmacy and vendor agreements), tracking terms, fees, renewal dates, and performance obligations.
• Supports review of new contracts and renewals in collaboration with the Pharmacy Director, Compliance, and Legal, in accordance with VG contracting policy.
• Evaluates contract language, fee structures, and data requirements, and recommends changes to the Pharmacy Director.
• Monitors vendor and contract pharmacy performance and compliance with contract terms.

Credentialing:

• Coordinates credentialing and re-credentialing of pharmacy clinical staff in partnership with VG’s Credentialing department, and supports the pharmacy privileging and scope-of-practice process.
• Verifies and tracks licenses, registrations, and certifications for pharmacy staff, and follows up before expiration dates.
• Maintains credentialing records in a secure and audit-ready manner.

Insurance Payment Reconciliation:

• Reconciles pharmacy claims and insurance payments to prescriptions dispensed, and identifies underpayments, denials, and discrepancies.
• Works with billing, finance, and pharmacy managers to resolve payment issues and close process gaps.
• Tracks payer reimbursement trends and reports exceptions and recovered amounts to the Pharmacy Director and finance.

Cross-Training and Backup Support:

• Cross-trains with the Pharmacy Operations Department Administrator so that each can cover the other’s work during absences.
• Provides backup technical support for Epic Willow when the Administrator is unavailable.
• Documents procedures so that coverage is possible and work continues without interruption.

Reporting:

• Prepares routine reports for the Pharmacy Director and leadership on audit results, corrective actions, license and credential status, contract status, and reconciliation findings.
• Maintains records related to job function and ensures an appropriate documentation and audit trail across areas of responsibility.
• Routinely communicates any questions, issues, or discrepancies to the appropriate authority.

Training and Education:

• Provides training and communication on 340B and pharmacy compliance requirements to pharmacy staff.
• Develops training and competency materials related to compliance as assigned.

Additional responsibilities:

• Perform other duties as assigned.

HIPAA Requirements:

• The Pharmacy Compliance Specialist will have access to protected health information (PHI) while carrying out his/her/their duties. This position uses PHI to verify 340B patient eligibility, audit pharmacy claims, reconcile insurance payments, and support quality and compliance reviews. Applying the minimum necessary standard of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the designated records sets to which this employee will have access include: the medical record as needed to verify eligibility, the pharmacy patient chart, the demographic, scheduling and insurance information of the practice management systems and all information in the pharmacy management computer system including billing and insurance information, prescription files, and patient profiles.

Knowledge, Skills and Abilities Required:

• Effective written and verbal communication skills.
• Working knowledge of, or ability to learn, 340B Program requirements and Oregon Board of Pharmacy requirements.
• Ability to apply regulatory compliance guidelines.
• Experience with insurance claims, remittances, and payment reconciliation.
• Computer skills (e.g., spreadsheets, pivot tables, data entry).
• Perform data analysis, critically evaluate data, and provide recommendations.
• Attention to detail and strong organizational skills, including tracking deadlines, renewals, and documentation.
• Familiarity with Epic or pharmacy dispensing software preferred; willingness to cross-train on Epic Willow support.
• Strong commitment to working with staff from a wide range of ethnic, economic, cultural and social backgrounds.
• Skilled in collaborating with decision-makers, influencing strategy and delivering financial results.
• Self-motivated and able to work independently to achieve positive results within a team environment.
• Bilingual English/Spanish preferred.

Education and Experience:

Required: High school diploma or GED; pharmacy technician experience at a Federally Qualified Health Center (FQHC); strong knowledge of the 340B Program. Preferred: Associate degree in business; 340B Apexus Certified Expert (340B ACE). State and Federal Pharmacy Requirements The employee in this position will be required to submit to background check; and may be required and must be willing to undergo drug screening at request of supervisor.

Behavioral Competencies:

Accountability

• Role model VG’s mission, vision, and shared values Customer-Focus
• Listen to the voice of the customer and strive to delight them by exceeding their expectations Teamwork
• If someone needs help, help them Initiative
• Be innovative, apply fresh ideas, and continuously improve how you do your work Confidentiality
• Maintain strict confidentiality and respect the privacy of others Ethical
• Demonstrate integrity, honesty, and stewardship in all encounters at work Respect
• Demonstrate consideration and appreciation for co-workers and patients Communication Demonstrate the ability to convey thoughts and ideas as well as understand perspective of others

Physical Requirements:

Percentage of time spent:

• Standing/Walking: up to 50%
• Sitting: up to 50%
• Lifting/Carrying: up to 5% - frequently 5-20 lbs; infrequent 20-40 lbs Stooping, Bending, Reaching: occasional

Working Environment/Physical Hazards:

• Work in well-lighted, ventilated environment
• Will be exposed to drug vapor or particles (powdered antibiotics that are reconstituted for example)
• May be exposed to potentially hazardous chemicals occasionally
• Position requires travel between VG clinic locations, employee must have reliable mode of transportation with valid driver’s license and personal car insurance.

Equipment Used:

Office equipment

• Computer: Pharmacy software, EPIC, databases, and word processing Telephone, Fax, Copier, Scanner

Immunization:

Staff member must meet immunizations requirements as stated in VGMHC’s immunization policy. Job description represent a general outline of the essential and major job duties, functions and qualifications required. They cannot be all-inclusive and comprehensive due to the dynamic nature of work performed to accomplish VGMHC’s Mission. VGMHC is an Equal Opportunity Employer. No person is unlawfully excluded from consideration for employment because of race, color, religious creed, national origin, ancestry, sex, age, veteran status, marital status or physical challenges. The policy applies not only to recruitment and hiring practices, but also includes affirmative action in the area of placement, promotion, transfer, rate of pay and termination.