Research Billing Compliance Analyst

Research Billing Compliance Analyst

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Salary Range: $65,000.00 - $

Job Requisition

Overview:
Reporting to the Director of Operations at the Yale Cancer Center Clinical Trials Office, the Research Billing Compliance Analyst is the primary liaison with the centralized hospital and professional billing offices. This role receives charges from these two offices for review and determination of appropriate billing designations, ensuring alignment with Medicare (CMS) regulations and institutional policies. The analyst maintains detailed records, monitors trends and risk areas, and communicates findings to relevant stakeholders.

Collaborating with clinical research staff, investigators, vendors, and administrators, the analyst supports policy development and process improvements to enhance billing compliance. Additional responsibilities include resolving billing discrepancies, staying current with federal regulations and best practices, and serving as a key resource and liaison for clinical trial billing. The analyst also contributes robust documentation and follow-up related to clinical trials billing within the Clinical Trial Management System.

Required

Skills and Abilities:

• Demonstrated ability with using clinical trial systems, protocol tracking and reporting. Advanced knowledge and experience with clinical trial regulatory documents such as protocols, informed consent documents, Medicare Coverage Analysis (MCA), and Clinical Trial Agreements (CTA).
• Outstanding verbal, written, communication and organizational skills, exceptional attention to detail, well-developed analytical and problem-solving skills, demonstrated superior customer service abilities and outstanding time management skills.
• Ability to possess sound, independent judgement, with ability to prioritize and handle many tasks simultaneously in a complex, fast-paced environment.
• Ability to work independently and effectively with a wide range of individuals.
• Strong computer skills required, including strong competency in Microsoft Office programs (Word, Excel, PowerPoint, etc.).

Preferred Education/

Experience:

• Experience working with oncology clinical trials;
  Medicare Coverage Analysis. Prior experience as a Clinical Research Coordinator or Clinical Research Nurse highly preferred.

Principal Responsibilities:

• Complete risk assessments on all MQT trials with billable services.
• Evaluate medical documentation, coding and billing for accurate ICD-10, CPT-4, HCPC and modifier placement in compliance with University and government regulations.
• Identify potential clinical research charges not specifically defined in research protocols.
• Review all billable services/encounters for designated studies utilizing OnCore and Epic.
• Evaluate findings, identify system control weaknesses and assist in the development of a corrective action plan.
• Maintain accurate logs of all ongoing investigations.
• Assist in the conduction of research training sessions with Principal Investigators and research related study teams and personnel.
• Conduct data analysis and generate reports using OnCore reporting tools.
• Stay abreast of best practice coding and billing initiatives and all pertinent regulatory changes.

Required

Education and Experience:

Bachelor's Degree in Health or Business Administration or a related field and 3 years of experience working directly with clinical research charge review and billing or an equivalent combination of education and experience.