Research Billing Compliance Specialist-Senior

University of Michigan; Ann Arbor (MI); Hybrid; USD 90,000 - 120,000; Full time

Job summary

University of Michigan is seeking a Senior Research Billing Compliance Specialist to serve as an advanced subject matter expert overseeing clinical research charges. You will ensure compliant billing, accurate charge routing, and defensible documentation across study accounts, working with MiChart and OnCore within a high-volume environment.

The role requires deep revenue cycle and clinical trial billing expertise, mentoring staff, and collaborating with research teams and leadership to improve

Qualifications

• Bachelor's Degree in Business, Finance, Health Information Management, or related field.
• Minimum five years in a healthcare revenue cycle or clinical operations role with billing/compliance experience.
• Advanced knowledge of CMS rules including NCD 310.1 and local determinations.
• Familiarity with CPT/HCPCS coding and hospital billing (UB-04/1500).
• Experience with electronic health record systems.

Responsibilities

• Analyze and perform complex review of daily hospital and professional charges for research trials using CA billing grid.
• Lead resolution of complex research billing discrepancies with corrections and timely outcomes.
• Partner with revenue cycle teams to investigate and resolve denials and root causes.
• Ensure charges are routed with correct modifiers, diagnoses and documentation.
• Provide guidance and education on clinical trial billing compliance to study teams and staff.
• Mentor intermediate staff and support onboarding and training.

Skills

CMS billing rules

CPT/HCPCS coding

MiChart

OnCore

Revenue cycle knowledge

Analytical skills

Education

Bachelor's degree in Business, Finance, Health Information Management or related field

Tools

MiChart

OnCore

Electronic health record systems

Job description

Research Billing Compliance Specialist-Senior

Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally.Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.

Job Summary

The Senior Research Billing Compliance Specialist serves as an advanced subject matter expert and senior individual contributor responsible for the accurate review, adjudication, and oversight of clinical research charges. Reporting to the Research Billing Compliance Lead, this role completes complex research billing compliance activities, including charge review, correction, and reconciliation, ensuring alignment with Coverage Analysis determinations, study billing grids, institutional policies, and applicable federal research billing regulations.

This position requires deep expertise in revenue cycle operations, clinical trial billing regulations, and system applications, including MiChart and OnCore. The Senior Specialist partners closely with research teams, billing stakeholders, and compliance leadership to ensure appropriate charge routing, defensible documentation, and compliant billing practices. This role serves as a key resource for issue resolution, driving timely and accurate outcomes for complex, high-risk, or non-standard billing scenarios while identifying trends and recommending process improvements.

The Senior Specialist is responsible for completing complex charge review for patients enrolled in clinical research studies in accordance with Medicare (CMS), other third-party payer requirements, and Clinical Trial Agreements (CTAs). This includes ownership of work queues, advanced charge and claim edit resolution, and denial management to ensure accurate and timely billing to study accounts, third-party payers, and patients. Additionally, the Senior Specialist provides guidance and mentorship to intermediate staff, supports training initiatives, and helps ensure ongoing compliance through quality assurance and continuous process improvement efforts.

Responsibilities*

• Analyze and perform complex review of daily hospital and/or professional charges for complex clinical trials generated across all hospital ordering systems to make determinations on charge segregation of items and services using the coverage analysis (CA) billing grid and other medical documentation.
• Lead the resolution of complex research billing discrepancies, including processing charge corrections and ensuring timely and accurate outcomes.
• Serve as a subject matter expert in partnering with revenue cycle teams to investigate, resolve, and prevent research-related denials, including identification of root causes and implementation of corrective actions.
• Ensure research charges are accurately routed with appropriate modifiers, diagnoses, and supporting documentation to meet compliant billing standards and regulatory requirements.
• Act as a primary resource for research billing inquiries, providing guidance and education to study teams, billing staff, and other stakeholders on clinical trial billing compliance.
• Independently manage and resolve complex or high-risk billing issues, escalating only the most ambiguous or systemic concerns to Lead or leadership as appropriate.
• Identify, analyze, and reconcile variances between hospital and professional billing entries against required charge routing based on the CA, including trend identification and recommendation of process improvements.
• Ensure adherence to all Michigan Medicine clinical research billing policies and procedures while promoting a culture of compliance, accountability, and operational excellence.
• Maintain advanced knowledge of Medicare Clinical Trial Policy (NCD 310.1), FDA regulations, and applicable federal and state requirements; proactively monitor regulatory updates and assess operational impact.
• Provide mentorship and guidance to intermediate staff, supporting onboarding, training, and ongoing competency development.

Required Qualifications*

Bachelor's Degree in Business, Finance, Health Information Management, or a related field; or equivalent experience/certifications.

Minimum of five years of experience in a healthcare revenue cycle or clinical operations role, with experience in healthcare compliance, general healthcare billing, research billing, or research billing compliance

Advancedknowledge of CMS billing rules and regulations such as National Coverage Determinations, Local Coverage Determinations, and specifically the Clinical Trial Policy (NCD 310.1).

Familiarity with CPT/HCPCS coding and hospital billing (UB-04/1500).

Experience with electronic health record systems.

• Bachelors Degree in Business, Finance, Health Information Management, or a related field; or equivalent experience/certifications.
• Minimum of three years of experience in a healthcare revenue cycle or clinical operations role, with experience in healthcare compliance, general healthcare billing, research billing, or research billing compliance
• Knowledge of CMS billing rules and regulations such as National Coverage Determinations, Local Coverage Determinations, and specifically the Clinical Trial Policy (NCD 310.1).
• Familiarity with CPT/HCPCS coding and hospital billing (UB-04/1500).

Experience with electronic health record systems.

Desired Qualifications*

• Bachelors Degree in Business, Finance or Healthcare field with a minimum of five years' experience in professional and hospital billing, facility coding process and/or reimbursement experience, including familiarity with the functions and compliance concerns related to revenue cycle activities.
• ACRP/SoCRA (or equivalent) certification preferred.
• Familiarity with government websites, and/or non-government websites and any other information systems needed during detailed review is expected.
• Knowledge of University of Michigan and UMHS policies, procedures as well as regulatory requirements.
• Proficient with MiChart, knowledge of IRB process, E-Research, Clinical Trial Protocols, OnCore and compliance.
• Strong analytical, organizational, and problem-solving skills.
• Demonstrated ability to meet or exceed institutional goals and priorities in a fast-paced, high volume workload environment.

Why Join Michigan Medicine?

Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. Michigan Medicine is comprised of over 30,000employees and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world's most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at Michigan Medicine and become a victor for the greater good.

What Benefits can you Look Forward to?

• Excellent medical, dental and vision coverage effective on your very first day
• 2:1 Match on retirement savings

Modes of Work

Positions that are eligible for hybrid or mobile/ #LI-Remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about the work modes .

Underfill Statement

This position may be underfilled at a lower classification depending on the qualifications of the selected candidate.

Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings.Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.

Application Deadline

Job openings are posted for a minimum of seven calendar days.The review and selection process maybegin as early as the eighth day after posting.Thisopening may be removed from posting boards and filled anytime after the minimum posting period has ended.

U-M EEO Statement

The University of Michigan is an Equal Opportunity Employer. We are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants, including protected veterans and individuals with disabilities.