Clinical Trial Coverage Analyst & Compliance Specialist - St. Josephs Candler

• Position Summary
  • The Clinical Trial Coverage Analyst & Compliance Specialist will be responsible for daily operations of managing billing compliance for clinical research studies within the oncology service line. This position will interpret study protocols for creation of coverage analyses, maintain documentation, and develop billing compliance policies and procedures. Due to the complex nature of clinical trials, this role will serve as a liaison between regulatory, clinical research, and billing departments to ensure compliance is followed throughout the lifecycle of a trial. He/she will provide support to investigators, clinical staff, and patients by ensuring adherence to billing regulations and overseeing financial aspects related to a portfolio of studies. Additional responsibilities include supporting audits, providing training regarding billing compliance, and leading continuous process improvement.
• Education
  • Bachelor's of Science - Required
  • Medical Billing or Coding, Revenue Cycle Denials Management, Project Management and Healthcare Analytics - Preferred
• Experience
  • 2-3 Years Clinical experience - Required
  • 3-5 Years Oncology, Clinical Research, Coding/Billing experience - Preferred
• License & Certification
  • Registered Nurse License with State of Practice - Required
  • Medical Coding Certi?cations such as CHC or CHRC – Required or obtain 18 months from date of hire
• Core Job Functions
  • Conduct comprehensive coverage analysis for clinical research studies to determine billable items and services through review of clinical trial protocols, contracts, and billing guidelines.
  • Implement and continuously evaluate Standard Operating Procedures for research patient care as it relates to research patient care billing within the health system.
  • Collaborate with principal investigators, clinical research coordinators, regulatory, and billing staff to gather necessary information for accurate billing.
  • Stay abreast of federal, state, and local regulations related to research billing and ensure adherence to billing guidelines.
  • Identify and optimize systems to streamline clinical research visibility and compliance across the health system.

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