Remote Senior Medicare Coverage Analyst & LCD/NCD Expert

Dana-Farber Cancer Institute, Inc.; Boston (MA); Ibrido; USD 78.000 - 90.000; Tempo pieno

Descrizione del lavoro

Dana-Farber Cancer Institute in Boston seeks a Medicare Coverage Analyst (MCA) to review protocols, consent forms, and trial agreements to prepare coverage analyses and billing guides. The role ensures which procedures are routine-cost and billable to insurance versus sponsor.

The Senior MCA provides subject matter expertise for complex protocols, mentors junior staff, develops analysis grids, and acts as a policy SME on LCD/NCD decisions, coordinating with study teams and sponsors.

Competenze

• Understanding of research activity in an academic medical center.
• Knowledge of billing compliance and Medicare regulations/policy, applicable federal, state, and local laws, rules, regulations and policies and institutional policies and standard operating procedures.
• Knowledge of clinical research budgeting and the clinical trial life cycle: study start-up through study closure.
• Knowledge of clinical trials management system (CTMS).
• Ability to independently facilitate outreach/communication between study team and sponsor.

Mansioni

• Mentors and trains junior MCA staff, provides second-level review of junior staff determinations.
• Creates coverage analysis grids for complex protocols.
• Serves as National and Local Coverage Determination (LCD and NCD) subject matter expert – disseminating changes to Medicare payor policy to other members of the MCA team.
• Triages and prioritizes coverage analysis workflow based on institutional need across disease centers – communicates MCA execution timelines to study teams and external stakeholders.
• Serves as the primary point of contact for urgent protocol amendments with budgetary and MCA impact, prioritizes and executes in narrow timelines.
• Independently interfaces with sponsors and sponsor representatives to resolve discrepancies in specific protocol assessments.
• Interfaces with study team and principal investigators prior to protocol submission to assist with MCA determinations/study design

Conoscenze

Medicare policy understanding

Billing compliance

Clinical trial budgeting

CTMS familiarity

Communication

Formazione

Bachelor's degree or RN credential

Strumenti

CTMS

Descrizione del lavoro

Dana-Farber Cancer Institute in Boston seeks a Medicare Coverage Analyst (MCA) to review protocols, consent forms, and trial agreements to prepare coverage analyses and billing guides. The role ensures which procedures are routine-cost and billable to insurance versus sponsor.

The Senior MCA provides subject matter expertise for complex protocols, mentors junior staff, develops analysis grids, and acts as a policy SME on LCD/NCD decisions, coordinating with study teams and sponsors.