[Hiring] Research Medicare Coverage Analysis Specialist @Cleveland Clinic

Role Description

As a Research Medicare Coverage Analysis Specialist, you will be responsible for determining qualifying clinical trial status and performing detailed coverage analyses in accordance with National Coverage Decision NCD310.1 and the Federal Clinical Trials Policy. In this role, you will report to the Director of Research Medicare Coverage Analysis and ensure compliant research billing practices by:

• Reviewing clinical trial protocols and regulatory documents to assess all patient care items and services required per the study.
• Determining the final billing designation for all procedures within a clinical research project.
• Making determinations of qualifying clinical trial status and performing detailed coverage analysis as required by NCD 310.1 and the Federal Clinical Trials Policy.
• Researching and applying policies from various sources such as federal, state, CMS website, and professional practice guidelines in making coverage determinations.
• Documenting justification for coverage analysis by citing specific resources for coverage determinations.
• Assisting in the management of claims review by applying the appropriate CDM and/or CPT codes for potentially billable items and services.
• Identifying items and services that are billable to the research sponsor.
• Collaborating and communicating effectively with the Principal Investigator and research team, patient financial services, clinical research billing office, IRB, and research compliance related to Medicare coverage analysis issues and determinations.
• Keeping current on FDA and Medicare regulations and state laws that apply to clinical trials for research billing.
• Assisting the MCA Director on the development of tools and billing grids for the Medicare Coverage Analysis process.
• Performing other duties as assigned.

Qualifications

• Bachelor’s degree in Healthcare Administration, Medical Coding, Auditing, Finance, Accounting, Nursing or a related field.
• In lieu of degree, six years of relevant experience in research billing, compliance, and/or direct involvement with sponsored clinical trials.
• Four years of relevant experience in research billing, compliance, and/or direct involvement with sponsored clinical trials.
• Ability to interpret and comprehend complex clinical research protocols, interpret research contracts, study budgets, and consent forms to extrapolate billing/coverage data.
• Strong organizational skills with ability to multi-task.

Requirements

• Ability to navigate CMS website.
• Coding experience.
• Scientific or healthcare background (i.e. Billing, clinical trials).
• Ability to perform work in a stationary position for extended periods.
• Ability to operate a computer and other office equipment.
• Ability to communicate effectively and exchange accurate information.
• Ability to travel throughout the health system.

Benefits

• Equal opportunity employment in a drug-free environment.
• Compliance with the influenza prevention program, including obtaining an influenza vaccination annually or obtaining an approved exemption.