Medicare Coverage & Research Billing Specialist

Cleveland Clinic; Cleveland (OH); Presencial; USD 58.000 - 88.000; Jornada completa

Descripción de la vacante

Cleveland Clinic is seeking a Research Medicare Coverage Analysis Specialist to determine trial status and perform detailed coverage analyses for clinical studies at the Main Campus. You will ensure compliant billing by reviewing protocols, budgets, and regulatory documents, and apply appropriate CDM/CPT codes where applicable.

You will collaborate with investigators and billing offices, stay current on FDA and Medicare regulations, and help develop tools for the Medicare Coverage Analysis

Formación

• Bachelor’s degree in Healthcare Administration, Medical Coding, Auditing, Finance, Accounting, Nursing or related field.
• In lieu of degree, six years of relevant experience in research billing, compliance, and/or direct involvement with sponsored clinical trials.
• Four years of relevant experience in research billing, compliance, and/or direct involvement with sponsored clinical trials.
• Ability to interpret and comprehend complex clinical research protocols, interpret research contracts, study budgets and consent forms to extrapolate billing/coverage data.
• Strong organizational skills with ability to multi-task.
• Preferred: CMS website navigation, Coding experience, healthcare background.

Responsabilidades

• Make determinations of qualifying clinical trial status and perform detailed coverage analysis as required by NCD 310.1 and the Federal Clinical Trials Policy.
• Ensure compliant research billing practices by reviewing protocols, regulatory documents, budgets and consent forms to assess patient care items and services.
• Research and apply policies from federal, state, CMS and professional guidelines in making coverage determinations.
• Document justification for coverage analysis with cited resources.
• Assist in claims review by applying CDM/CPT codes and identifying billable items for sponsors.
• Collaborate with PI, research team, patient financial services, billing office, IRB and compliance on Medicare coverage issues.
• Stay current on FDA and Medicare regulations and state laws affecting trials.
• Assist MCA Director in developing tools and billing grids for Medicare Coverage Analysis.
• Other duties as assigned.

Conocimientos

Interpret complex protocols and study–

Educación

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

Descripción del empleo

Cleveland Clinic is seeking a Research Medicare Coverage Analysis Specialist to determine trial status and perform detailed coverage analyses for clinical studies at the Main Campus. You will ensure compliant billing by reviewing protocols, budgets, and regulatory documents, and apply appropriate CDM/CPT codes where applicable.

You will collaborate with investigators and billing offices, stay current on FDA and Medicare regulations, and help develop tools for the Medicare Coverage Analysis