UPMC · 5 hours ago
Research Specialist, ONC - (Coverage Analyst)
United States
Full-time
Remote
Mid Level
3+ years expUPMC Hillman Cancer Center is internationally recognized for its leadership in cancer care and research. They are seeking a Research Specialist - Coverage Analyst to ensure financial compliance and proper coverage of clinical trial procedures, collaborating with various teams to support accurate financial planning and billing for clinical trials.
BiotechnologyHealth CareHospitalMedical
Responsibilities
Perform detailed coverage analysis of clinical trial protocols to distinguish billable versus non-billable items and services
Ensure 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
Collaborate with clinical research teams to develop accurate study budgets based on coverage analysis findings
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
Synchronizes the final coverage analysis with appropriate final study documents
Maintain up-to-date knowledge of healthcare billing regulations, payer policies, and clinical trial reimbursement guidelines
Assist with the resolution of billing discrepancies related to clinical trial services
Provide training to research staff on coverage analysis and compliant billing practices
Qualification
Required
Bachelor's degree in health-related field
3 years of experience in clinical trials
Knowledge of clinical research protocol and budgeting is required
Excellent analytical skills with attention to detail
Strong organizational and time management skills
Excellent communication and interpersonal skills
Ability to work independently and as part of a team
Preferred
1 year of experience in Medicare coverage determination preferred
Clinical Research Professional Certification or related certification is a plus
Company
UPMC
UPMC is one of the leading nonprofit health systems in the United States. A $10 billion integrated global health enterprise headquartered
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$0.46MKey Investors
Appalachian Regional Commission
2024-09-18Grant· $0.46M
Leadership Team
Leslie Davis
President and CEO
Frederick M. Hargett
Chief Financial Officer
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