Medicare Coverage Analytics Specialist (Clinical Trials)

ccf; United States; Hybrid; USD 85,000 - 105,000; Full time

Job summary

Cleveland Clinic Health System is seeking a Research Medicare Coverage Analysis Specialist at the Main Campus in Cleveland. You will determine trial status and perform detailed coverage analyses, ensuring compliant billing per study protocols and regulatory documents.

You will collaborate with the PI and research teams, apply CMS and FDA guidelines, and help develop tools for Medicare Coverage Analysis. After 90 days, the role transitions to a hybrid schedule with some days onsite.

Qualifications

• Ability to interpret and comprehend complex clinical research protocols and contracts.
• Strong organizational skills with the ability to multi-task across studies.
• Experience reviewing protocols, regulatory documents and study budgets for billing.
• Excellent collaboration with Principal Investigators and cross-functional teams.

Responsibilities

• Determine qualifying clinical trial status and perform coverage analyses per NCD310.1.
• Review protocols and regulatory documents to assess patient care items and services.
• Apply FDA, CMS policies to make coverage determinations.
• Document justification with cited resources for coverage decisions.
• Assist in claims review by applying CDM and CPT codes for billable items.
• Collaborate with investigators, patient financial services and billing office.
• Stay current on FDA and Medicare regulations and state laws affecting trials.
• Assist in developing tools and billing grids for Medicare Coverage Analysis.

Skills

Interpret complex protocols

Organizational multi-tasking

Stakeholder communication

Education

Bachelor's degree in Healthcare Administration

Job description

Cleveland Clinic Health System is seeking a Research Medicare Coverage Analysis Specialist at the Main Campus in Cleveland. You will determine trial status and perform detailed coverage analyses, ensuring compliant billing per study protocols and regulatory documents.

You will collaborate with the PI and research teams, apply CMS and FDA guidelines, and help develop tools for Medicare Coverage Analysis. After 90 days, the role transitions to a hybrid schedule with some days onsite.