Clinical Research Reimbursement Compliance Analyst - Cardiology
The Clinical Research Reimbursement Compliance Analyst is dedicated to ensuring billing compliance for clinical research. The Analyst will identify, in the EPIC system, which medical procedures and services may qualify as 'Routine Cost' and be billable to patient insurance, and which should be charged to the study. This team member plays a crucial role in evaluating clinical research protocols, Informed Consent Forms, Clinical Trial Agreements and other pertinent study documents to determine billing compliance. The Clinical Research Revenue Integrity Analyst will partner closely with research teams to assure an accurate and consistent approach to research billing compliance.
- Performs review of all hospital (technical) and professional charges generated in EPIC
- Identifies and allocates charges to the research study account, insurance claim and/or patient statement as they compare to the research billing plan outlined in the protocol Billing Grid, protocol and study budget
- Verifies and resolves discrepancies by interacting with hospital and professional billing personnel and research teams utilizing tools and resources available – billing grid, protocol and study budget
- Collaborates with the clinical research department administrators and study coordinators to develop billing grid as necessary
- Must, be detailed oriented and perform all reviews in a timely manner
- Attend meetings as applicable
- Complete all internal trainings required for systems access
- Other duties as assigned
- Bachelor’s degree in Health Information Management (HIM), Healthcare Administration, Medical Coding, Business Administration, Public Administration, Healthcare Management, or related field with coursework relating to healthcare operations includes the following topics: Medical Terminology, Human Anatomy and Physiology, ICD-10 Coding, and CPT Coding, or closely related courses.
3 years of experience working directly with clinical charge review and billing or an equivalent combination of education and experience.
Demonstrated ability to work independently and collaboratively in a team-based, collegial environment