Clinical Trial Budget & Coverage Analyst

Sutter Health; Oregon; Hybrid; USD 97,000 - 146,000; Full time

Job summary

Sutter Health is seeking a Coverage Analysis Specialist to join our system office team in Oregon. The role focuses on determining qualifying clinical trials for coverage and performing initial and final billing analyses to assure federally compliant reimbursement.

You will review protocols, budgets, and payer rules, collaborate with investigators and sponsors, and document evidence of medical necessity to support accurate insurance payments.

Qualifications

• Bachelor's degree or equivalent education/experience.
• 5 years of relevant experience.
• Knowledge of CPT/HCPCS billing and research-related claims.
• Understanding of regulatory compliance in clinical trials.

Responsibilities

• Determine qualifying status of clinical trial studies and perform initial coverage analysis.
• Review protocols, budgets, and consent templates to document billing support.
• Submit documents for coverage activation and notify Noridian when needed.
• Assist in interpreting Medicare/Medicaid coverage decisions and payer rules.
• Collaborate with research affiliates, investigators, and sponsors to ensure compliant reimbursement.
• Support standardization of administrative and financial processes for trial billing compliance.

Skills

Clinical research concepts

Medicare/Medicaid knowledge

Regulatory compliance

Billing and reimbursement

Communication skills

Microsoft Word/Outlook/Excel

Attention to detail

Independent decision making

Team collaboration

Education

Bachelor's degree or equivalent

Job description

Sutter Health is seeking a Coverage Analysis Specialist to join our system office team in Oregon. The role focuses on determining qualifying clinical trials for coverage and performing initial and final billing analyses to assure federally compliant reimbursement.

You will review protocols, budgets, and payer rules, collaborate with investigators and sponsors, and document evidence of medical necessity to support accurate insurance payments.