Remote Medicare Coverage Analyst & Billing Specialist

Actalent

Orlando (FL)

Remote

USD 55,000 - 63,000

Part time

6 days ago

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Job summary

Actalent is seeking a Coverage Analysis, Program Coordinator to conduct comprehensive MCA reviews and ensure compliant billing for clinical trials.

Responsibilities include interpreting protocols, applying CMS guidelines, and collaborating with study teams to maintain accurate budgeting and billing plans in a fully remote environment. Requires strong Medicare knowledge and CTMS/EMR familiarity.

Qualifications

Bachelor's degree or higher in healthcare, life sciences, finance, or related field.
At least 4 years of experience in clinical research billing, coverage analysis, or healthcare compliance.
Strong knowledge of Medicare regulations and clinical trial billing practices, including CMS NCD 310.1.

Responsibilities

Audit Medicare Coverage Analysis (MCA) for new and ongoing clinical trials to ensure accurate and compliant billing practices.
Interpret clinical trial protocols to identify billable services and distinguish between routine patient care and research-related costs.
Apply CMS NCD 310.1 and other guidelines when assessing coverage and billing.
Collaborate with study teams, investigators, and billing departments to design and maintain accurate billing plans for trials.
Develop and maintain detailed billing grids and coverage analysis documentation.
Assist in development and negotiation of clinical trial budgets with sponsors.
Ensure consistency across informed consent forms, contracts, and billing plans.
Support audits related to clinical trial billing and Medicare Coverage Analysis.