Clinical Trial Budget Analyst

Sutter Health; Sacramento (CA); On-site; USD 97,000 - 146,000; Full time

Job summary

Sutter Health is seeking a qualified analyst to determine whether studies qualify as clinical trials and to perform initial coverage analyses, ensuring federally compliant billing for research services. The role involves evaluating protocols, budgets, and payer rules, interfacing with investigators and sponsors, and applying CPT/HCPCS decisions within SHS research operations.

Qualified candidates will have a Bachelor's degree (or equivalent) and about 5 years of relevant experience, with strong

Qualifications

• Bachelor's degree or equivalent education/experience required.
• Minimum 5 years of relevant experience.
• Knowledge of CPT/HCPCS, Medicare/Medicaid billing and national/local coverage determinations.
• Ability to interpret Medicare/Medicaid coverage decisions and payer rules.
• Strong communication and collaboration skills across teams.

Responsibilities

• Determine qualifying status of studies and perform initial coverage analyses.
• Review protocol documents, sponsor budgets, and contracts to document billing support.
• Confer with investigators, sponsors, and payer entities to ensure compliant reimbursement.
• Interpret guidance and apply local and national coverage determinations to clinical trial items.
• Support billing determinations and document harmonization of study-related materials.

Skills

Clinical research concepts

Regulatory compliance

Medicare/Medicaid knowledge

CPT/HCPCS knowledge

Analytical thinking

Attention to detail

Communication skills

Education

Bachelor's degree or equivalent education/experience

Tools

Microsoft Word

Outlook

Excel

Job description

We are so glad you are interested in joining Sutter Health!

Organization

SHSO-Sutter Health System Office-Valley

Position Overview

Responsible for determining if a study is a qualifying clinical trial, and performing the initial coverage analysis review by analyzing individual research protocol clinical services to assure federally compliant billing and reimbursement. Ensuring complete submission of documents required to conduct a coverage analysis and activate a study and submitting notification of participation letter to Noridian (MAC) when needed. Determining and documenting billing support for clinical items by reviewing the protocol, investigator brochures, sponsor budget, sponsor proposed contract, and consent template, the evidence of medical necessity justifications, and appropriate payers of protocol-specific services and federally required research-related claims modifications for service payment by insurance. Conducting the final review and analysis of study documents to assure all study-related documents are harmonized. Interpreting Medicare/Medicaid coverage decisions, national guidelines as they apply to specific clinical trial medical items and services. Supporting Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) billing determinations of clinical trial items and services and applying all applicable local coverage decisions, national and local coverage determinations, and third-party payer rules for clinical trial coverage analyses. Interfacing with various Sutter Health research affiliates, administrative staff, principal investigators, essential partners, and clinical trial sponsors regarding reimbursement for research services. Implementing an integrated support function that standardizes the administrative and financial support functions of clinical trial billing compliance thereby improving service to the Sutter Health research community and providing an increased level of research compliance.

Education

• Bachelors or equivalent education/experience

Typical Experience

• 5 years recent relevant experience

Skills And Knowledge

• Demonstrated knowledge of clinical research concepts, good clinical practices and regulatory compliance.
• Knowledge of Medicare benefit categories, statutory exclusions, and national and local coverage determination and of national medical practice guidelines, Food and Drug Administration investigational drug and device research.
• Knowledge of medical coding, protocol visit span allowances, protocol-specified clinical services, and basic research study demographics of clinical research financial activities and documentation required before study initiation, including research protocol, internal budget, sponsor contract and budget, and consent template.
• Demonstrated written, oral, electronic communication; presentation and interpersonal skills.
• Ability to use multiple technical systems as intended; ability to collaborate across revenue cycle, compliance, and research operations teams; and attention to detail.
• Analytical and computer skills, including proficiency in Microsoft Word, Outlook, and Excel.
• Ability to work independently and to accept responsibility for complex and sensitive decision making as it relates to the position.
• Outstanding organization skills to manage many competing timetables and responsibilities.
• Demonstrated leadership skills, including team building, and coaching/mentoring with the ability to motivate and engage others.
• Ability to build and establish effective working partnership with employees, peers and/or leaders to achieve business objectives.
• Verbal and written communication, and interpersonal skills.
• Organizational and time management skills, with the ability to prioritize multiple projects while delivering quality service and achieving business results.
• Demonstrates tactical and analytical thinking and planning skills, and is able to develop plan to accomplish objectives, identify obstacles and resolve operational issues.
• Demonstrated skill in communicating and collaborating with Sutter Health essential partners (Legal Services, ECS, SHIRB) and research institute personnel.

Job Shift

Days

Schedule

Full Time

Days Of The Week

Monday - Friday

Weekend Requirements

None

Benefits

Yes

Unions

No

Position Status

Exempt

Weekly Hours

40

Employee Status

Regular

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $97,032.00 to $145,558.40 / annual salary. Bay Area Pay Range is $111,592.00 to $167,398.00 / annual salary.

The posted pay range is based on the position's primary work location. Candidates who reside and work outside of that location may be subject to a different pay range based on their work location. Candidate starting salaries consider multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.