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Naples Comprehensive Health - NCH · 13 hours ago

Research Billing Specialist

Naples, FL

Full-time

Onsite

Entry, Mid Level

2+ years exp

NCH is an independent, locally governed non-profit delivering premier comprehensive care. The Research Billing Specialist manages the billing processes related to clinical research studies, ensuring accurate and compliant billing to sponsors, insurers, or third-party payers while collaborating with various teams for timely processing of study-related charges.

Health CareMedical

Responsibilities

Works closely with Coding, Revenue Cycle, Compliance, and Research Teams to deliver accurate, complete, and timely claims

Oversee and collaborates with the day-to-day clinical research billing and reimbursement activities

Maintains, reviews, and understands ICH-GCP guidelines and clinical research billing and reimbursement regulations. Collaborate with internal and external stakeholders to resolve billing and reimbursement issues

Provide exceptional customer service by responding to inquiries related to billing and reimbursement

Reviews all charges for NCHRI clinical trial-related services, communicating relatedness to a research trial and identifying the correct Payer according to research protocols and contract agreements

Works closely with members of the research team to determine which services are covered by the clinical trial sponsor and which are standard of care, ensuring accurate billing to appropriate party

Continues to keep up to date with relevant federal regulations, clinical trial guidelines and institutional policies supported by information and education provided by the NCH Billing and Coding Team

Analyze billing/reimbursement data to identify trends, generate reports, and contribute to process improvements

Diligently works/reviews billing reports and work queues to decrease bill hold accounts

Assist with patient questions regarding research-related bills

Conducts internal audits to ensure compliance in: Accurate Billing: Processing and verifying correct research study charges, including lab tests, procedures, and treatments

Compliance: Ensuring adherence to billing policies, coverage determinations, regulations, and guidelines through education and updates from NCH Billing and Coding Department

Liaison: Serving as a point of contact for research coordinators and payers, addressing questions and resolving concerns

Training and Support: Providing ongoing training and support to staff on complex research billing workflows

Data Entry and Filing: Performing general administrative duties related to research billing

Reviews the EPIC work queue daily of all NCHRI research accounts, evaluating and processing all assigned patient accounts for relatedness to Research and payee source in a timely and accurate manner

Reviews clinical trial protocols to determine billing requirements and ensure appropriate charge segregation

Assist in the development and maintenance of coverage guide and billing grids in collaboration with research, finance, and study teams; provides specific reimbursement guides provided by study sponsors to billing and coding teams

Identify and resolve discrepancies between clinical trial activities and billing records to prevent erroneous or duplicate charges

Works comfortably with established research earning and billing software foundations and serves as a resource for research related learning and compliance

Communicate with sponsors, CROs, and internal departments regarding billing inquiries and corrections

Participate in audits and corrective action plans related to research billing compliance

Stays updated on changes in research-related billing compliance regulations and educate team members as needed

Represents NCH Research Institute in committees and external organizations in a professional, knowledgeable, and cooperative manner at all times, collaborating effectively with multidisciplinary teams

Qualification

Medical billing practicesCoding CPTCoding HCPCSCoding ICD-10EPIC softwareClinical Trial management systemsHealthcare AdministrationAnalytical skillsOrganizational skillsEffective communicationAttention to detailCollaboration skills

Required

Minimum High School or GED required

Ability to communicate effectively with researchers, patients, and payers

Ability to work with accuracy and attention to detail in a fast-paced environment

Strong analytical and organizational skills

Ability to collaborate effectively with multidisciplinary team

Preferred

Associate or Bachelor's degree in Healthcare Administration, Business, or related field preferred

Minimum of 2 years in an academic clinical research environment preferred

Understanding of medical billing practices, coding and compliance

Knowledge of coding (CPT, HCPCS, ICD-10) and coverage analysis principles is preferred

Familiarity with billing software and electronic health record systems, specifically EPIC

Familiarity with Clinical Trial management systems is a plus

Company

Naples Comprehensive Health - NCH

Glassdoor3.6

Naples Comprehensive Health (NCH) is an Advanced Community Healthcare System™ in Naples, Florida, serving Southwest Florida with premier routine, critical, and specialty care.

Founded in 1953

Naples, Florida, USA

1001-5000 employees