Yale University · 1 day ago
Research Billing Compliance Analyst
United States
Full-time
Remote
Mid Level
$65K/yr - $101K/yr
3+ years expYale University is seeking a Research Billing Compliance Analyst to join the Yale Cancer Center Clinical Trials Office. This role involves ensuring billing compliance with Medicare regulations, maintaining records, monitoring trends, and collaborating with various stakeholders to enhance billing processes.
AssociationBusiness DevelopmentEducationMedicalSocial Entrepreneurship
Responsibilities
Primary responsibilities include the completion of risk assessments on all MQT trials with billable services. The level of risk is determined utilizing the CTMS (OnCore) risk assessment tool as well as the clinical trial documentation and information provided within the study’s protocol. Once the risk assessment is complete and all trials scored, random selection of the highest risk trials will be assessed and reviewed for accurate research billing compliance and proper medical documentation
Medical documentation, coding and billing will be evaluated 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. Work collaboratively with the Office of Sponsored Projects to determine proper documentation alignment including but not limited to the informed consent forms, research protocols, clinical trial agreement and trials finalized budget
Review all billable services/encounters for designated studies utilizing OnCore and Epic. Communicate and supply YNHHS Compliance department with ongoing reviews and assist with any information requested in order to ensure accurate and consistent billing for both professional and hospital charges
Evaluate findings, identify system control weaknesses and in conjunction with department management, assist in the development of a corrective action plan for Principal Investigator and study team. Assist in the implementation and follow up of all corrective action changes
Maintain accurate logs, including spreadsheets, of all ongoing investigations. Enter all review findings in the OnCore registry database Identify and analyze any trends and report findings to the Associate Director, Research Billing Compliance
Assist in the conduction of research training sessions with Principal Investigators and research related study teams and personnel. Provide subject matter expertise and input on areas where education is needed. Assist in the development of training materials and programs for research billing compliance, including but not limited to accurate coding, documentation billing and regulatory guidelines
Conduct data analysis. Generate reports using OnCore reporting tools to identify trends and problem areas for focus of internal reviews
Assist and support with the ongoing implementation of the Research Billing Compliance Program as well as knowledge retention and maintenance of the Yale School of Medicine’s Research Billing Compliance Plan, operations and procedures
Stay abreast of best practice coding and billing initiatives as well as all pertinent regulatory changes. Maintain CPC designation by obtaining necessary CEUs on an annual basis
Qualification
Required
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
Outstanding time management skills
Ability to possess sound, independent judgement
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.)
Bachelor's Degree in Health or Business Administration or a related field
3 years of experience working directly with clinical research charge review and billing or an equivalent combination of education and experience
Preferred
Experience working with oncology clinical trials
CPC certification
Company
Yale University
Yale University is a research and education institution that prioritizes its students.
10001+ employees
H1B Sponsorship
Yale University has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (355)
2024 (449)
2023 (214)
2022 (208)
2021 (190)
2020 (155)
Funding
Current Stage
Late StageTotal Funding
$42.86MKey Investors
Bezos Earth FundAlfred P. Sloan FoundationHyundai Hope On Wheels
2025-10-23Grant
2025-05-21Grant· $0.05M
2023-01-01Grant· $1.27M
Leadership Team
Geoffrey Chatas
Senior Vice President for Operations
Jack Callahan
Senior Vice President for Operations
Recent News
2025-12-10
Company data provided by crunchbase