Clinical Trials Revenue Cycle Billing Compliance; Research Regulatory Oversight​/Sr. Enterprise Financial Mgmt); CHRC

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Organization:

Charge Master Admin

Job Summary:

Perform prospective reviews of research related/clinical trial processes that directly impact the integrity of billing to federal/non-federal sponsors and claims billed to governmental and non-governmental payors. Assists with audits of information related to study protocols/grid development, Medicare Coverage Analysis audits, and audits of charge segregation functions impacting billed charges to federal grants, sponsored contracts and insurance payors. Special projects may arise from requests made by senior revenue cycle leadership, Office of Legal Counsel, Office of Compliance and Corporate Integrity and Research Executive Administration.

Should be able to initiate and plan projects with a high degree of autonomy and provide summaries of issues and corrective actions to various levels of executive leadership. Analysis of impacts to insurance and patient billing will be audited as part of project assignments. The non-supervisory position reports to the AVP of Finance, VP of Revenue and Reimbursement, or other designated finance executive within the Office of Finance/Revenue Cycle..CHRC

(Certification in Healthcare Research Compliance) and/or CHC (Certified in Healthcare Compliance) preferred.

Familiarity with OnCore Clinical Trials Management System strongly preferred.

Job Description:

The Regulatory Oversight Specialist – Research (non-supervisory) is responsible for planning and leading projects related to the management of clinical research. Reviews will include but may not be limited to performing prospective review of study protocols, billing grid development and research charge segregation activities. Study activities reviewed evaluate compliance with CMS regulations for billing of research studies (Medicare Coverage Analysis, claim presentation, and billing of charges to federal grants/sponsored projects.

Review of EPIC charge transactions and chart documentation will be required as part of work assignments.

The Regulatory Oversight Specialist – Research position wis expected to work independently and have strong analytical and regulatory knowledge related to the management and billing of clinical trials and clinical registries. The position will require intermediate to expert skills in assembling and analyzing data in Excel, reviewing professional and hospital charging and billing/collection transactions in EPIC, and providing accurate and concise PowerPoint summaries to various departments including Revenue Cycle, Office of Legal Counsel, Office of Compliance and Research Administration.

Essential Duties and Responsibilities:

Lead prospective and retrospective reviews of study protocols, billing grid development and research charge segregation functions.

Analyze compliance with CMS regulations for billing of research studies and clinical registries by auditing Medicare Coverage Analysis, Coverage with Evidence Development (CED) guidelines, medical documentation in EPIC, and insurance and patient billing and collection transactions.

Perform special projects related to…