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Cleveland Clinic · 1 day ago

Research Medicare Coverage Analysis Specialist

Cleveland, OH

Full-time

Hybrid

Mid, Senior Level

$58K/yr - $88K/yr

4+ years exp

Cleveland Clinic is a respected healthcare organization seeking a Research Medicare Coverage Analysis Specialist. This role involves determining clinical trial status and performing detailed coverage analyses to ensure compliant billing practices in research projects.

Health CareHospitalMedicalNon Profit

Responsibilities

Make determinations of qualifying clinical trial status and perform detailed coverage analysis as required by NCD 310.1 and the Federal Clinical Trials Policy

Ensure compliant research billing practices are followed by reviewing clinical trial protocols, related regulatory documents, clinical trial agreements, informed consent documents, documents from the FDA and CMS, and the study budget to assess all patient care items and services per the study protocol

Research and apply policies from various sources such as federal, state, CMS website and professional practice guidelines in making coverage determinations

Document justification for coverage analysis by citing specific resources for coverage determinations

Assist in the management of claims review by applying the appropriate CDM and/or CPT codes for potentially billable items and services as well as identifying items and services that are billable to the research sponsor

Collaborate and communicate effectively with the Principal Investigator and research team, patient financial services, clinical research billing office, IRB and research compliance related to Medicare coverage analysis issues and determinations

Keep current on FDA and Medicare regulations and state laws that apply to clinical trials for research billing

Assist the MCA Director on the development of tools and billing grids for the Medicare Coverage Analysis process

Other duties as assigned

Qualification

Medicare Coverage AnalysisClinical Trial ProtocolsResearch Billing ComplianceMedical CodingRegulatory Document ReviewMulti-taskingScientific BackgroundOrganizational SkillsCommunication Skills

Required

Bachelor's degree in Healthcare Administration, Medical Coding, Auditing, Finance, Accounting, Nursing or a related field

In lieu of degree, six years of relevant experience in research billing, compliance, and/or direct involvement with sponsored clinical trials

Four years of relevant experience in research billing, compliance, and/or direct involvement with sponsored clinical trials

Ability to interpret and comprehend complex clinical research protocols, interpret research contracts, study budgets and consent forms to extrapolate billing/coverage data

Strong organizational skills with ability to multi-task

Preferred

Coding or Research experience

Ability to navigate the CMS website to determine local and national coverage decisions

Scientific or healthcare background (i.e. Billing or clinical trials)

Benefits

Healthcare

Dental and vision benefits

Retirement savings account contributions

Company

Cleveland Clinic

Glassdoor3.6

Cleveland Clinic is a non-profit medical center that combines clinical and hospital care with research and education. It is a sub-organization of Ashtabula Regional Medical Center.

Founded in 1921

Cleveland, Ohio, USA

10001+ employees