Clinical Trial Budget & Reimbursement 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

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