Medicare Coverage Analytics Specialist (Hybrid)

ccf; United States; Híbrido; USD 85.000 - 110.000; Jornada completa

Descripción de la vacante

Cleveland Clinic Health System is seeking a Research Medicare Coverage Analysis Specialist to determine qualifying clinical trial status and perform detailed coverage analyses per NCD 310.1 and the Federal Clinical Trials Policy.

You will review protocols, regulatory documents, and budgets to ensure compliant billing and accurate CPT coding. The role supports building the centralized MCA Office and requires collaboration with investigators and billing offices.

Formación

• Bachelor's degree or six years of relevant experience in research billing, compliance, or sponsored clinical trials.
• Excellent written and oral communication with multiple stakeholders.
• Ability to interpret complex clinical research protocols, contracts, budgets, and consent forms.
• Ability to manage high-volume workload and meet deadlines.

Responsabilidades

• Determine qualifying clinical trial status and perform detailed coverage analyses per NCD 310.1 and Federal Clinical Trials Policy.
• Review protocols, regulatory documents, informed consent, FDA/CMS documents, and budgets to assess patient care items.
• Apply policies from federal/state CMS guidelines and professional practice guidelines for coverage determinations.
• Document coverage justification with cited resources for determinations.
• Assist in claims review and apply CDM/CPT codes for billable items, identifying charges to sponsors.
• Collaborate with Principal Investigator, research team, patient financial services, and compliance offices on determinations.
• Stay current on FDA and Medicare regulations and state laws affecting clinical trials.
• Develop tools and billing grids for Medicare Coverage Analysis processes.
• Other duties as assigned.

Conocimientos

Healthcare administration

Effective communication

Policy interpretation

Time management

Educación

Bachelor's degree in Healthcare Administration, Medical Coding, Auditing, Finance, Accounting, Nursing or related field

Six years of relevant experience in lieu of degree

Descripción del empleo

Cleveland Clinic Health System is seeking a Research Medicare Coverage Analysis Specialist to determine qualifying clinical trial status and perform detailed coverage analyses per NCD 310.1 and the Federal Clinical Trials Policy.

You will review protocols, regulatory documents, and budgets to ensure compliant billing and accurate CPT coding. The role supports building the centralized MCA Office and requires collaboration with investigators and billing offices.