Clinical Research Coverage Analyst - Orlando Health
Orlando, FL 32806
About the Job
The Clinical Research Coverage Analyst performs the Coverage Analysis of all clinical trial protocols managed by Corporate Office of Research Operations in support of maintaining a compliant research billing program.
Responsibilities:Essential Functions
• Initiates Coverage Analysis of all sponsored trials managed by Corporate Office of Research Operations.
o Applies knowledge of applicable Medicare Billing rules (NCD310.1).
• Facilitates completion of Revenue Compliance Worksheet.
o Liaises with Principal Investigator and other Research personnel when needed.
• Reviews clinical trial protocols and related regulatory documents in order to prepare a billing plan for all medical procedures
and services required in a clinical research project.
• Ensures consistency of the payment terms in the coverage analysis with the protocol, the informed consent form template, the budget, and the contract payment terms.
• Manages framework for reconciliation of patient charges and compliance of clinical research payments.
• Reconciles daily patient charges with Coverage Analysis and Revenue Compliance Worksheet.
• Interacts with sponsor to correct budget issues such as those resulting from unexpected non-coverage of study procedures.
• Performs financial tracking and audits of patient accounts.
• Liaises with departments including patient access, pharmacy services, supply chain and others as needed.
• Attends and leads individual department research meetings as appropriate.
• Acts as liaison between clinical research team and research billing personnel.
• Develops and conducts continuing education related to research billing compliance issues in conjunction with the Corporate Manager, Research Revenue Cycle.
Other Related Functions
• Educates research team members about regulatory rules, charge capture and reconciliation.
• Participates in process improvement and quality-related initiatives associated with study execution and deliverables.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards.
• Maintains compliance with all Orlando Health policies and procedures.
• Performs other duties as assigned.
Education/Training
• Bachelor's degree in a health or science related discipline required.
• Strong ability using spreadsheet and database software for moderately complex financial analysis and reports.
• Strong ability with database applications, and computer software programs necessary for the proper function of office including Excel and Word.
• Knowledge and understanding of the Revenue Cycle in a hospital.
• Knowledge of Medicare, Medicaid, Medicare OPPS and other third-party billing rules and coverage.
• Knowledge of applicable federal regulations governing the conduct of clinical research.
Licensure/Certification
None
Experience
• Requires Two (2) years of clinical or hospital experience or one (1) year of management experience within a hospital
AND
• Requires two (2) years’ experience in either clinical trials operations or revenue cycle.