Clinical Research Coverage Analyst Remote

Company Description

Renowned as the academic flagship of the University of Maryland Medical System, our Magnet®-designated facility is a nationally recognized, academic medical center with opportunities across the continuum of care. Come join UMMC and discover the atmosphere where talents and ideas come together to enhance patient care and advance the science of nursing. Located in downtown Baltimore near the Inner Harbor and Camden Yards, you won’t find a more vibrant place to work!

General Summary

Under limited supervision, and with the latitude for initiative and independent judgment, performs, coordinates, and manages the creation and outsourcing of billing analysis in accordance with the Center for Medicaid and Medicare Services (CMS) regulations and the Clinical Trial Policy for all clinical trials. The billing analysis must be compliant with the Medicare billing rules.

This position also serves as liaison with the investigators, research teams, healthcare providers, budgeting and contracting offices at UMMS and UMB, and in coordination with departmental clinical trial management processes. This position works with various systems including Epic and HPM Explorer for the purpose of segregating charges to ensure compliant billing for research services as well as providing pricing for budgeting purposes.

Principal Responsibilities And Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

• Serves as liaison and contact with the clinical research teams and healthcare providers.
• Reviews and resolves invoice discrepancies with the Central Billing Office and the study teams,
• Segregates charges in Epic by distinguishing research charges billed to the study versus those research charges that can be billed to insurance.
• Applies CMS regulations, FDA guidance, and ethical policies when performing coverage analysis.
• Creates Epic RSH Records and Fee Schedules for each research study.
• Develops the coverage analysis including reviewing each potentially billable item within the clinical trial and citing specific resources for justification of the appropriate designations.
• Responsible for the dissemination of relevant documents and information to various parties.
• Synchronizes the final coverage analysis with appropriate final study documents.
• Triages coverage analysis requests to our coverage analysis vendor when applicable. Acts as the intermediary between the vendor and the study teams during coverage analysis creation, tracks progress, and reports results.
• Other duties as assigned.
• Performs monthly coverage analysis and charge segregation audits to ensure ongoing compliance.
• Collaborates with research teams in performing the coverage analysis, as well as facilitating the clinical trial management process involving UMB, UMMS, and FPI.
• Applies the appropriate CDM and/or CPT codes for potentially billable items in the coverage analysis in order to assist in the management of claims review, as well as identifying items that are to be billed to the sponsor via the budgeting and contract teams at the Office of Research and Development (ORD) at University of Baltimore (UMB).
• Creates coverage analysis grids and analyzes the performance of the actual coverage analysis.
• Researches and applies policies, guidance and guidelines from various sources including federal, state, UMMS and the University of Maryland Baltimore (UMB).
• Researches and applies regulations and law related to Medicare regulations, OIG regulations, FDA guidance, and related compliance documents using various resources including computer search modalities.
• Performs basic and complex billing and budget analysis in accordance with CMS regulations for all clinical trials performed at UMMS affiliates and FPI practice offices and clinics.

Qualifications

Education and Experience

• Four (4) years of clinical research experience required. Additional experience may be substituted for the educational requirement on a year-for-year basis for up to four (4) years.
• Certification in Healthcare Research Compliance or Epic preferred.
• Bachelor’s degree in Healthcare Administration, Medical Coding, Auditing, Finance, Accounting, Nursing, or a related field required.

Knowledge, Skills, And Abilities

• Demonstrated skill tracking clinical and corporate contracts using electronic administration software such as Grant.gov, CICERO, OnCore, Epic, etc.
• Skill in cost/financial accounting and clinical trial management software.
• Knowledge of principles and practices pertaining to developing and administering a clinical trial in compliance with sponsor, federal, state, UMMS and University of Maryland Baltimore regulations.

Additional Information

All your information will be kept confidential according to EEO guidelines.