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UPMC · 20 hours ago

Research Specialist - Coverage Analyst

Pittsburgh, PA

Full-time

Hybrid

Mid Level

3+ years exp

UPMC is a healthcare organization seeking a Clinical Trial Coverage Analyst responsible for ensuring billing compliance and proper coverage of clinical trial procedures. This role involves collaborating with clinical research teams and finance departments to ensure accurate financial planning and billing for clinical trials.

BiotechnologyHealth CareHospitalMedical

Responsibilities

Performs detailed coverage analysis of clinical trial protocols to distinguish billable versus non-billable items and services

Synchronizes final coverage analysis with appropriate final study documents

Maintain up-to-date knowledge of healthcare billing regulations, payer policies, and clinical trial reimbursement guidelines

Ensures compliance with Medicare's Clinical Trial Policy and other payer regulations related to clinical research billing

Applies the appropriate CDM and/or CPT codes for potentially billable items in the coverage analysis in order to assist in the management of claims review, as well as identifying items that are to be billed to the sponsor via the budgeting and contract teams

Collaborates with clinical research study teams to develop accurate study budgets based on coverage analysis findings and drives operational alignment up to study activation

Aligns coverage determinations within OnCore

Identify and document which study costs should be covered by the study sponsor versus the payer. Communicate findings to clinical research coordinators, investigators, and financial teams

Assist with the resolution of billing discrepancies related to clinical trial services

Provide training to research study teams on coverage analysis and compliant billing practices

Qualification

Clinical Trial Coverage AnalysisHealthcare Billing RegulationsClinical Research ProtocolEPIC EHROnCore CTMSClinical Research Professional CertificationAnalytical SkillsCommunication SkillsOrganizational SkillsTeamwork