Children's National Hospital · 1 day ago
Sr. Clinical Research Coverage Analyst
Maryland-Silver Spring
Full-time
Onsite
Senior Level, Lead/Staff
8+ years expChildren's National Hospital is seeking a Sr. Clinical Research Coverage Analyst responsible for reviewing clinical research protocols and determining the qualification of clinical trials under Medicare policies. The role involves ensuring compliance with billing processes and providing training on relevant regulations.
AssociationChild CareHealth CareNon Profit
Responsibilities
Develops Coverage Analysis (CA) on CMS policy and National and Local Coverage Determinations. Review clinical research protocols, informed consent forms, sponsor agreements and and determines which procedures are routine, and therefore, billable to Medicare and other third party payers
Code each procedure per the applicable CPT coding guidelines. Identify appropriate research modifiers to be places on claims
Documents CA determinations to to support the decision-making process. This documentation may be subject to inspection by CMS and regulatory agencies
Determines whether a study is a qualifying clinical trial under CMS Clinical Trial Policy
Builds calendars and coverage analysis in OnCore
Participates in the development of clinical research budgets as needed, assisting to provide justification for costs, etc. working collaboratively with Business Office staff
Review to the protocol for language that will impact the coverage analysis revise appropriately
Maintain a current knowledge of laws and regulations governing professional fee billing, Medicare' Clinical Trial Policy and newly issued guidance. Develops and provides training on these topics for for investigators and CNH research and administrative staff
Assist with the development of policies and procedures pertaining to clinical research billing compliance, including the CA process
Performs regular research billing reviews to identify billing compliance and develop and implement corrective actions
Other duties as required
Anticipate and responds to customer needs; follows up until needs are met
Demonstrate collaborative and respectful behavior
Partner with all team members to achieve goals
Receptive to others’ ideas and opinions
Contribute to a positive work environment
Demonstrate flexibility and willingness to change
Identify opportunities to improve clinical and administrative processes
Make appropriate decisions, using sound judgment
Use resources efficiently
Search for less costly ways of doing things
Speak up when team members appear to exhibit unsafe behavior or performance
Continuously validate and verify information needed for decision making or documentation
Stop in the face of uncertainty and takes time to resolve the situation
Demonstrate accurate, clear and timely verbal and written communication
Actively promote safety for patients, families, visitors and co-workers
Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance
Qualification
Required
Bachelor's Degree Healthcare, scientific, or related field (Required)
8 years experience in research administration (Required)
Expert knowledge of Medicare Clinical Trial Policy (NCD 310.1), National and Local Coverage Determinations (NCDs LCDs), Code of Federal Regulations (CFRs), state laws, and professional practice guidelines
Knowledge of regulations regarding human subjects in clinical research, outcomes research, nursing research, and other research areas
Proficient working knowledge of Microsoft Office Suite including Excel and multiple IT systems
Experience with OnCore Clinical Trials Management System (CTMS) is required
Effective verbal, written and interpersonal communication skills
Ability to organize/prioritize time and work independently
Ability to apply generalized information to specific situations
Knowledge of drug/device development process and the pharmaceutical and/or medical device manufacturing industry
Preferred
BSN, RN, LPN or MD (Preferred)
Company
Children's National Hospital
Children’s National Hospital, based in Washington, D.C., was established in 1870 to help every child grow up stronger.
Founded in 1870Washington, District of Columbia, USA
5001-10000 employees
H1B Sponsorship
Children's National Hospital 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 (82)
2024 (55)
2023 (92)
2022 (59)
2021 (41)
2020 (51)
Funding
Current Stage
Late StageTotal Funding
$19.4MKey Investors
Gilbert Family FoundationAdvanced Research Projects Agency for HealthUnited Health Foundation
2025-10-09Grant· $8M
2024-10-23Grant· $8M
2021-11-09Grant· $3.4M
Leadership Team
Kurt Newman
President and CEO
Michelle Riley-Brown, MHA, FACHE
President and CEO
Recent News
BioWorld Financial Watch
2025-06-07
Company data provided by crunchbase