Posted in Other 30+ days ago.
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Type: Full Time
Location: Kansas City, Missouri
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A Clinical Trials Coverage Analyst is responsible for reviewing clinical research protocols, Informed Consent Forms, Clinical Trial Agreements, and other relevant study-related documents. The Coverage Analyst determines whether proposed clinical research studies are a qualifying clinical trial as defined by the Medicare Clinical Trial Policy (NCD 310.1), while also being cognizant of Medicare/Medicaid Benefit Policies, third-party Medical Benefit Policies, relevant National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), Code of Federal Regulations (CFRs), state laws, professional practice guidelines, claims denial reports from the Institution and, when necessary, consult with the Medicare Administrative Contractor (MAC) for the region. The Coverage Analyst will create a billing justification plan or "coverage analysis" to reflect which medical procedures/services may be "Routine Cost" and billable to patient insurance and which should be billed to the study sponsor. The Coverage Analyst will develop coverage analysis or billing risk analysis on investigator-initiated, industry-sponsored, and non-industry sponsored clinical trials across multiple disciplines and clinical conditions. He/she will also work directly with the study sponsor or CRO to develop/negotiate study budgets and payment terms during the initial study start-up phase as well as during the study for protocol amendments to ensure site budgets account for all changes to study plans. In addition, the Coverage Analyst develops preliminary internal study budgets to look at financial feasibility and may provide guidance to the study team or leadership based on their analysis. He/she must also ensure that all study-related costs are captured, and the study budget aligns with the coverage analysis, Informed Consent Form(s), and Clinical Trial Agreement through a process of document concordance. The Coverage Analyst collaborates with Principal Investigators, project managers, study coordinators, investigational pharmacists, and other research and administrative staff to further develop coverage analysis billing plans and confirm procedural codes (CPT and HCPCS) and non-coded services (e.g. effort and supplies). The position integrates diverse elements of clinical trial management and requires creativity, teamwork, and collegiality to develop and maintain sound fiscal and related administrative systems and ensure billing compliance in a highly regulated atmosphere.
This position is responsible for ensuring institutional research activity billing compliance with all applicable federal, state, and local laws, rules, regulations and policies and institutional policies and standard operating procedures.
* Bachelor's degree
* OR 3-5 years' experience
* RN preferred
* RNs who reside in Kansas are required to hold a Kansas Multi-State (Compact) License upon hire
* RNs who reside in Missouri are required to hold a Missouri Multi-State (Compact) License upon hire
* Refer to Nursing and Advanced Practice Provider Licensure and Certification policy for required Life Support Certifications required upon hire
* Software Application Skills (e.g. Microsoft Office Suite)