Hybrid Research Medicare Coverage Analyst

Cleveland Clinic; Cleveland (OH); Hybrid; USD 58,000 - 88,000; Full time

Job summary

Cleveland Clinic’s 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 the Federal Clinical Trials Policy. You will report to the Director of Research Medicare Coverage Analysis and ensure compliant research billing practices for all procedures within a clinical study.

A caregiver works days 8:00 a.m.–5:00 p.m.

Qualifications

• Bachelor’s degree or equivalent in healthcare/finance-related field.
• Ability to interpret complex clinical research protocols and budgets.
• Strong organizational and multitasking capabilities.

Responsibilities

• Make determinations of qualifying clinical trial status and perform detailed coverage analyses per NCD 310.1.
• Review clinical trial protocols, regulatory documents, and budgets to assess patient care items and services.
• Apply federal, state, CMS guidelines to make coverage determinations.
• Document justification for coverage decisions with cited resources.
• Assist in claims review by applying CDM and CPT codes for billable items.
• Collaborate with Principal Investigator and research team to resolve Medicare coverage issues.
• Stay current on FDA and Medicare regulations impacting research billing.

Skills

Organizational skills

Multi-tasking

Interpret complex protocols

Education

Bachelor’s degree in Healthcare Administration or related field

Job description

Cleveland Clinic’s 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 the Federal Clinical Trials Policy. You will report to the Director of Research Medicare Coverage Analysis and ensure compliant research billing practices for all procedures within a clinical study.

A caregiver works days 8:00 a.m.–5:00 p.m.