Position: Coverage Analysis Specialist (12 month contract)Address: Pittsburgh, PA 15261 (remote)Position Summary: Seeking a Coverage Analysis Specialist to play a critical role in ensuring compliance with Medicare's clinical trial policy and institutional billing practices. This position involves thorough review and analysis of clinical research studies to support accurate and compliant billing for clinical trial-related services, safeguarding the institution’s financial integrity and regulatory adherence. Key Responsibilities:
Medicare Qualification Review:
Evaluate clinical trials to determine whether they meet qualifying criteria under Medicare’s clinical trial policy.
Coverage and Billing Analysis:
Analyze all procedures in clinical research protocols, applying payer coverage rules to assess whether the study qualifies as a covered study and identify which procedures are the responsibility of the research sponsor, the subject's insurance carrier, or the patient.
Collaboration with Research Teams:
Work closely with investigators, study teams, and coding resources to clarify protocol requirements and ensure alignment on billing indicators for each procedure.
Data Entry and Documentation:
Accurately document billing indicators and qualifiers in the Clinical Research Management System (CRMS) to ensure correct tracking and reporting.
Billing Consistency:
Maintain consistency between CRMS and EPIC billing grids, verifying that all billing information aligns accurately across systems.
Medical Device Study Approvals:
Facilitate the process of obtaining required approvals for studies involving medical devices, ensuring adherence to all necessary regulations.
Charge Report Review:
Review EPIC research charge reports for accuracy, promptly addressing and resolving any discrepancies to ensure accurate billing.
Minimum Qualifications:
Bachelor’s degree in Finance, Business Administration, Healthcare, or a related field.
At least 5 years of experience with research budgeting and/or hospital billing processes.
Solid understanding of Medicare’s clinical trial policy.
Demonstrated experience working closely with physicians and/or research study teams.
Knowledge of medical terminology and vocabulary.
Familiarity with clinical research funding, IRB requirements, and electronic medical records (EMRs).
Preferred Qualifications:
Previous experience in coverage analysis within a clinical research setting.
Knowledge and experience with coding.
Competencies:
Action-Oriented: Takes initiative and works proactively.
Technical Skills: Demonstrates strong functional and technical skills in coverage analysis.
Interpersonal Skills: Builds and maintains effective relationships with study teams, physicians, and other stakeholders.
Organizational Skills: Efficiently manages time and resources.
Analytical Skills: Approaches problems with logical, structured analysis.
Time Management: Prioritizes tasks and meets deadlines effectively.
Communication Skills: Articulates ideas clearly and professionally in written and verbal formats.
Diversity Respect: Demonstrates respect for diverse perspectives and backgrounds.
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System One, and its subsidiaries including Joulé, ALTA IT Services, CM Access, TPGS, and MOUNTAIN, LTD., are leaders in delivering workforce solutions and integrated services across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible full-time employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.
