Clinical Research Coverage Analyst
- Location: Scarborough, ME
- Posted: Dec 14, 2018
The Clinical Research Coverage Analyst is a crucial role in the organization launching a new clinical studies and ensuring billing is compliant. This position supports the mission towards a collaborative interface between the research departments Clinical Research Coordinators, Principal Investigators (PI) and the billing process. It is a holistic approach that guides the Maine Health organization toward achieving operational efficiency, complete regulatory compliance, and total reimbursement. The Clinical Research Coverage Analyst will review each study protocol and informed consent to determine each medical service the patient will receive to develop the Medicare Coverage Analysis (MCA).
Required Minimum Knowledge, Skills, and Abilities (KSAs)
Education:Technical or bachelors degree preferred or one (1) to three (3) years equivalent and related work experience required in finance/coding/billing or billing for services rendered to a patient in a clinical trial in the hospital setting or healthcare industry.
Certification:Applicable professional certification through AHIMA (CCA) or AAPC (CPC A, COC-A) is preferred. Must obtain professional credential within One Year of employment. Obtain Epic Proficiency for Research Billing within six months.
Experience:EPIC HB/PB experience preferred.
Proficiencies: Knowledge of revenue cycle processes and hospital/ medical billing. Understanding of components of electronic medical record. Knowledge of code data sets to include CPT, HCPCS, ICD 10, Revenue codes, Value Codes and Conditions codes. Knowledge of NCCI edits, and Medicare LCD/NCDs as well as Medicare Manuals.
Knowledge: Preferred knowledge and familiarity with navigating clinical research protocols.
Abilities: Due to its service focus, this position requires interpersonal and communication skills, analytic and organizational skills, and the ability to meet deadlines. Computer skills; MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.
Maintain an understand Clinical Trial Medicare policies, articles, etc. including but not limited to Medicares Clinical Trial Policy NCD 310.1, Medicares Claim Processing Manual 100-4 Chapter 32- section 68 and 69, and Medicares Benefit Policy Manual 100-2 Chapter 14.
Perform a comprehensive review of any documents related to a research study which could include the study budget, protocol, informed consent or other supporting documentation in order to determine if the study is a qualifying clinical trial.
Complete a MCA for all medical procedures, services, pharmaceuticals and supplies for each visit that is part of the clinical study based on Medicare manuals and policies as stated including determining if the service is routine care or research related.
Ensure each visit is billed appropriately to the study or the patient with all of the claim requirements including ICD-10 diagnosis, Modifiers, Condition Codes, Value codes and corresponding clinical trial number. Maintain the accounts in a timely manner within the research related work queues to not delay billing of claims.
Works with Research Departments to invoice, track and collect payments to reconcile accounts.
Be a resource for the Research department, PIs and the Revenue Cycle
Maintain organization and record keeping for all research documents
May perform other duties as assigned.
Clinical Research Coverage Analyst
Thank you for your interest in this position.
Please note, this application is to be used by current employees of Maine Medical Center or MaineHealth System employees applying to another MaineHealth organization only. Other applicants must utilize the external application.
- Full Time
Schedule: Day Shift