Consultant | Healthcare Performance Improvement | 340B, Pharmacy and Clinic Services ID-2452

Description & Requirements

The Healthcare Consulting Performance Improvement team is looking for a Consultant to join the team in supporting clients in the Pharmacy and Clinic Services space specifically as it relates to compliance, program optimization, and financial performance.

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How You Will Contribute
  • Assist with Financial/Reimbursement assessments to determine reimbursement opportunities for on-campus and off-campus provider-based departments as well as freestanding and provider-based Rural Health clinics.
    • Responsible for the financial analysis proactive calculations and modeling of new regulatory changes and impacts
    • Assist with PowerPoint presentation reports
  • Assist with developing provider-based strategy, gap assessments, and transition advisory processes. Provide guidance to clients regarding provider-based departments.
    • Operational Assistance
    • Split-billing (technical/professional)
    • Chargemaster requirements
    • CMS Provider-Based Clinic regulations and Federal and State regulations
    • Compliance with provider-based rule requirements
    • CMS Checklists
      • Assimilate provider-based checklists (attestations)
  • Assist with transitions to Rural Health Clinic (RHC) or Provider Based RHC
    • Policy and Procedure Development
    • Survey readiness assistance
    • Become proficient in provider-based (42 CFR 413.65) and RHC regulations and stay abreast of ongoing legislative changes.
    • Prepare Medicare RHC cost reporting schedules.
      • Calculating RHC visits
      • Calculating FTEs for productivity
  • Provide guidance to clients regarding their 340B and other pharmacy operations:
    • Policy and Procedure Development
    • 340B network expansion i.e., development of contract pharmacy arrangements, child sites, direct purchases, orphan drugs, and other opportunities
    • Operational Assistance
      • Split-billing vendor implementations
      • Split-billing vendor maintenance i.e., Drug Crosswalk Maintenance
    • Compliance Reviews
      • Independent Reviews
      • HRSA Audit Experience a plus
  • Advise, communicate, and present to all levels including C-suite, management, and clinic staff.
  • Provide in-depth provider-based processes and regulatory knowledge to clients.
  • Provide an unmatched client experience and identify additional value-added services
  • Active participant in specific healthcare industry groups (Becker's, Apexus, 340B Health, HFMA, etc.)

We Are Looking For People With Forward Vision And

  • Strong analytical and communication skills
  • Ability to deliver work products consistently and with high-quality.
  • Demonstrated ability to think independently and train other team members as needed.
  • Ability to travel up to 50%, depending on client commitments.
  • Highly motivated and self-driven to exceed client needs and timelines.

Minimum Qualifications

  • Bachelor's degree in Business, Accounting, Finance, Health Services Administration, or a related field
  • 2 years or more of experience working within the healthcare industry, specifically consulting or with a hospital
  • Significant experience in advanced Excel, IT platforms, and healthcare
  • Strong technical skills, experience with spreadsheets, databases, and an automated audit work paper system
  • Experience with project management

Preferred Qualifications

Experience in the following areas:

  • Healthcare provider-based billing
  • Provider-based attestation compliance and submission to Medicare
  • Medicare/Medicaid Hospital cost reporting
  • Practice operational knowledge in provider-based physician practices, or RHCs.
  • EPIC
  • Data visualization (Tableau or Power BI)

Consultant | Healthcare Performance Improvement | 340B, Pharmacy and Clinic Services ID-2452

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