Hybrid Medicare Coverage Analysis & Research Billing Specialist

Cleveland Clinic; Arkansas; Hybrid; USD 85,000 - 110,000; Full time

Job summary

Cleveland Clinic Main Campus is seeking a Research Medicare Coverage Analysis Specialist to determine qualifying clinical trial status and perform detailed coverage analyses in accordance with NCD 310.1 and Federal Clinical Trials Policy.

You will review protocols, regulatory documents, and budgets to assess patient care items, finalize billing designations, and collaborate with investigators and billing offices while staying current on FDA and Medicare regulations.

Qualifications

• Bachelor’s degree or equivalent in healthcare billing and research compliance.
• Six years of relevant experience in research billing or sponsored trials.
• Strong ability to interpret complex clinical study protocols and budgets.

Responsibilities

• Determine qualifying clinical trial status and perform detailed coverage analyses.
• Review protocols, regulatory documents, and budgets to assess billing items.
• Apply federal and state policies to make coverage determinations.
• Document justification for coverage determinations citing resources.
• Assist in claims review by applying CDM and CPT codes for billable items.
• Collaborate with Principal Investigator and billing offices on Medicare coverage issues.
• Stay current on FDA and Medicare regulations affecting research billing.
• Assist in tool and billing grid development for Medicare Coverage Analysis.

Skills

Analytical skills

Healthcare coding

Research billing

Regulatory compliance

Communication

Education

Bachelor’s degree in Healthcare Administration or related field

Six years experience in research billing or sponsored trials (in lieu of degree)

Four years experience in research billing or sponsored trials

Job description

Cleveland Clinic Main Campus is seeking a Research Medicare Coverage Analysis Specialist to determine qualifying clinical trial status and perform detailed coverage analyses in accordance with NCD 310.1 and Federal Clinical Trials Policy.

You will review protocols, regulatory documents, and budgets to assess patient care items, finalize billing designations, and collaborate with investigators and billing offices while staying current on FDA and Medicare regulations.