Clin Research Coverage Analyst

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Job description

Position Summary:
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.

Qualifications:
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
• Two (2) years of clinical or hospital experience or one (1) year management experience within a hospital.
• Requires two (2) years' experience in either clinical trials operations or revenue cycle.

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