Clinical Research Coverage Analyst

Sanford Health; South Dakota; Remote; Full time

Job summary

Join Sanford Health as a Clinical Research Coverage Analyst, responsible for conducting Medicare Coverage Analyses for clinical trials, particularly focusing on oncology and specialty trials. This full-time role offers development opportunities in a supportive healthcare environment, with competitive pay and a comprehensive benefits package.

Benefits

Health insurance

Dental insurance

Vision insurance

401(k) retirement plan

Generous time off

Qualifications

• Bachelor’s degree required.
• Minimum of two years’ experience in clinical research, coding or clinical trial billing preferred.

Responsibilities

• Conduct Medicare Coverage Analyses for clinical research studies.
• Ensure compliance with federal and institutional billing regulations.
• Collaborate with study teams and support trial activation processes.

Skills

Analytical skills

Organizational skills

Communication skills

Education

Bachelor's degree in healthcare administration, life sciences, nursing, finance, or related field

Tools

Clinical Trials Management System (CTMS)

Electronic Medical Records (EMR)

Job description

Join to apply for the Clinical Research Coverage Analyst role at Sanford Health

Join to apply for the Clinical Research Coverage Analyst role at Sanford Health

Careers With Purpose

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Careers With Purpose

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Facility: Remote SD (Central Time)

Location: Remote, SD

Address

Shift: 8 Hours - Day Shifts

Job Schedule: Full time

Weekly Hours: 40.00

Salary Range: $24.00 - $38.50

Job Summary

The Clinical Research Coverage Specialist/Analyst is responsible for conducting accurate and timely Medicare Coverage Analyses (MCA) for clinical research studies, with a primary focus on oncology trials, specialty trials, and investigator-initiated trials (IITs) within an integrated health system. This role ensures compliance with federal and institutional billing regulations, promotes financial integrity in clinical research, and supports effective trial startup and management. This role may be hybrid or remote from specific states. Occasional on-site presence may be required for meetings, audits, or training. Key Responsibilities:

Perform detailed Medicare Coverage Analysis for clinical trials, evaluating each protocol to determine the billing designation for all study-related procedures and services.

Interpret clinical trial protocols, informed consent documents, budgets, and related materials to identify billable services in accordance with CMS National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and applicable laws and guidance.

Develop and document billing grids aligned with MCA determinations to distinguish between routine costs billable to third-party payers and those covered by the study sponsor or grant.

Collaborate with study teams, principal investigators, budget analysts, and compliance personnel to ensure clarity, consistency, and accuracy of MCA results and associated billing plans.

Support the activation process for oncology, specialty, and investigator-initiated trials by providing MCA deliverables within defined timelines.

Maintain current knowledge of billing compliance requirements and research-related regulatory changes, particularly related to Medicare rules and National Coverage Determination (NCD) 310.1.

Participate in audits and monitoring activities related to billing compliance and coverage determinations.

Assist with continuous process improvement initiatives to enhance the efficiency and quality of coverage analysis processes.

Provide education and support to research staff on billing compliance and the implications of MCA outcomes.

Assist with building, reviewing & making changes to financial builds in the Clinical Trials Management System (CTMS).

Education And Experience

Bachelor’s degree in healthcare administration, life sciences, nursing, finance, or related field required.

Experience performing Medicare Coverage Analysis in a healthcare or clinical research setting; experience with oncology trials strongly preferred.

Experience with coverage analysis for investigator-initiated and specialty trials in an academic or integrated health system is highly desirable.

Certification in Clinical Research Billing (e.g., ACRP, SOCRA, or CRB from the Society of Clinical Research Associates or a similar body) is a plus.

Knowledge And Skills

In-depth understanding of clinical research operations, protocol design, and billing compliance requirements.

Proficiency in interpreting Medicare regulations, NCD/LCD policies, and research billing guidelines.

Familiarity with clinical trial management systems (CTMS), electronic medical records (EMR), and billing systems.

Strong analytical, organizational, and communication skills.

Ability to work both independently and collaboratively in a fast-paced, regulated environment.

Qualifications

Bachelor’s degree required.

Minimum of two years’ experience in clinical research, coding or clinical trial billing preferred.

Benefits

Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits .

Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to [e-mail] .

Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.

Req Number: R-0226320

Job Function: Research

Featured: No

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Research, Analyst, and Information Technology

• Industries

  Hospitals and Health Care

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