Clinical Trial Billing Coordinator

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

Analyzes and resolves complex clinical trial patient accounts. Responsible for establishing, updating and implementing procedures regarding the billing of clinical trials. Responsible for identifying work flow issues, developing suggestions for improvement, and providing in-services to other areas regarding the clinical trial processes. Produces a variety of computerized reports regarding the clinical trail processes, including registration, billing, and collections. Works closely with various departments throughout the SBO, Hospital, and Yale University to ensure that departmental financial and compliance objectives are achieved.

Responsible for ensuring that all charges related to clinical trials are billed appropriately to either insurance(s) or the Clinical Trial Coordinator/Principal Investigator by reviewing multiple computer systems and interpreting clinical treatment plans for each patient within each clinical trial in conjunction with the various services being charged for hospital services.

EEO/AA/Disability/Veteran

• Performs detailed analysis of potential clinical trial accounts by identifying charges billable to insurance and separating charges that are part of the clinical trial by creating the appropriate accounts. Uses good planning and problem-solving methods and resourcefulness to resolve issues (including any system problems). Follows up on accounts by contacting both internal and external sources to obtain the clinical information needed to substantiate charges as part of the clinical trial.
  • Utilizes various computer systems to access daily work file to correctly identify accounts with potential clinical trial charges and establishes any necessary accounts to be billed appropriately.
  • Initiates effective follow up by contacting clinical trial coordinators and/or patients to obtain additional information necessary to resolve any issues holding up the bill.
  • Contacts Medical Records, reviews clinical information available on a variety of systems and interprets clinical treatment plans and protocols for the patient to determine the status of the charges.
  • Identifies and resolves edits in the systems which may be holding up the billing process.
  • Ensures subsequent follow up activity is established and adheres to a timely schedule to follow up on accounts.
  • Documents all follow up activity on the account in the system in a clear concise manner, in order to aid in the resolution of the account and for future reviews.
• Using excellent analytical and decision-making skills manages the clinical trial accounts in the file. Determines which accounts should be billed to clinical trials or to health insurance, written off, re-billed or appealed to health insurance and refer to the appropriate parties. Looks for ways to continually to improve the process resulting in charges being billed to either clinical trials or health insurance appropriately.
  • Demonstrates a thorough knowledge and understanding of each phase of the process and a familiarity with all systems involved. This includes a complete understanding of clinical trial procedures and third party billing requirements in order to effectively carry out assigned duties.
  • Determines appropriate reimbursement methodology and applies to clinical trial accounts according to established protocol/trial.
  • Verifies the accuracy of proration and makes adjustments to accounts as necessary and with respect to developed fee schedule.
  • When…