Clinical Trial Reimbursement Specialist

Fadona; St. Louis (MO); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare organization is seeking a Clinical Trial Reimbursement Specialist to ensure billing compliance for clinical trials. This remote role requires critical thinking and knowledge of research regulations. Ideal for BSN candidates looking to leverage their nursing experience.

Benefits

Medical, dental, vision insurance

Disability insurance

Pension and 403(b) plans

401(k) match

Tuition assistance

Paid Time Off

Qualifications

• 2-5 years of experience required.
• No supervisor experience needed.

Responsibilities

• Review protocols and contracts for billing compliance.
• Perform detailed reviews and finalize billing recommendations.
• Analyze billing compliance audits and coordinate with study teams.

Skills

Critical Thinking

Research Regulations

Education

Bachelor's Degree in HIM, Nursing, or related field

Job description

Additional Information About the Role

BJC HealthCare is seeking a Clinical Trial Reimbursement Specialist. This remote role will review clinical trial documents to ensure billing compliance according to Medicare billing rules and the legal documents.

Great opportunity for a BSN candidate who is looking to use nursing experience in a new way!

Monday-Friday position with ideal candidates living in the Greater St. Louis area.

Overview

BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois, and southeast Missouri regions. With net revenues of $6.3 billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban, and rural communities through its 14 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care, and hospice.

BJC is the largest provider of charity care, unreimbursed care, and community benefits in Missouri. It provides $785.9 million annually in community benefits, including $410.6 million in charity care and financial assistance, ensuring access to medical care regardless of ability to pay. Additional community benefits are provided through research, emergency preparedness, regional health care safety nets, health literacy, outreach, and economic development.

Patients benefit from advances in medical science through a formal affiliation between Barnes-Jewish Hospital and St. Louis Children’s Hospital with Washington University School of Medicine, ranked among the top medical schools nationally.

Preferred Qualifications

Role Purpose

Review protocols, informed consent, fully executed contracts with budgets to support coverage analysis development per master agreements and Medicare guidelines. These documents help identify procedures, creating a billing matrix and assigning financial responsibility to the study or patient insurance. The billing matrix will include all study services and timeframes, supporting billing compliance. It will be shared with revenue management to split claims between study and/or patient insurance.

Responsibilities

• Use critical thinking and understanding of research regulations to ensure accurate billing matrices and compliance with research billing requirements, MOUs, and research agreements. Validate information for correct coding and billing for each enrollee.
• Perform detailed reviews of protocols, contracts, informed consents, and supporting documents to conduct comprehensive coverage analysis and finalize billing recommendations.
• Analyze routine research billing compliance audits, respond to revenue management inquiries, review charges and billing matrices, and coordinate with study teams to ensure proper billing. Notify revenue management of errors for review.
• Understand clinical trial pricing strategies to assist research teams in budget preparation and rate explanation. Liaise with BJC entities to identify trials not supported by billing matrices.
• Maintain workflow processes to build billing matrices based on departmental priorities, working closely with research teams and liaisons. Meet weekly productivity goals to ensure timely, accurate claims filing.

Minimum Requirements

Education

• Bachelor's Degree in HIM, Nursing, or related field

Experience

• 2-5 years

Supervisor Experience

• None

Licenses & Certifications

• RN or RHIA

Benefits and Legal Statement

BJC Total Rewards

We offer comprehensive benefits to support your well-being, including:

• Medical, dental, vision, life insurance, and legal services from day one
• Disability insurance (paid by BJC)
• Pension and 403(b) plans
• 401(k) match
• Tuition assistance from day one
• Learning and development resources
• Flexible Spending Accounts
• Paid Time Off including vacation, sick, holidays, and personal days
• Adoption assistance

Learn more at www.bjctotalrewards.com/Benefits

*Benefits may vary by position

This description provides a general overview and is not exhaustive. BJC is an Equal Opportunity Employer.