Research Billing Coverage Analysis Coordinator

UNC REX Healthcare; Remote; USD 60,000 - 80,000; Full time

Job summary

A healthcare organization is looking for a Research Billing Coverage Analysis Coordinator in Chapel Hill, NC. This role involves analyzing clinical research services compliance with Medicare policies, collaborating with study teams, and preparing billing analyses. Requires a Bachelor's degree and relevant experience. The position operates full-time, primarily remote, with competitive compensation ranging from $31.04 to $44.62 per hour.

Qualifications

• Requires one year of related experience with a Bachelor's degree.
• Requires five years of related experience with an Associate's degree.

Responsibilities

• Review research protocols and create coverage analyses according to Medicare's guidelines.
• Apply Hospital and/or CPT codes for billing items.
• Consult on study budgets and ensure treatment costs are included.
• Document coverage determinations with supporting citations.
• Serve as a liaison with UNC Health Billing Office.

Education

Bachelor's degree or equivalent

Job description

Description

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.

Summary: The Research Billing Coverage Analysis Coordinator will analyze protocol-driven clinical research services to ensure that both routine and research services are properly identified and billed in compliance with the Medicare Clinical Trial Policy, national and local laws and regulations, as well as institutional billing policies. The position will also meet with study teams to review the billing grid prior to study start up and collaborate with study teams to assess study readiness prior to activation. Under limited supervision, and with the latitude for initiative and independent judgment, performs, coordinates, and manages the creation and outsourcing of billing analysis in accordance with the Medicare Clinical Trial Policy, national and local laws, and regulations, as well as institutional billing policies. The BCA Analyst applies subject matter expertise to complex protocols. The documented analysis will serve as the basis for study budget creation and patient charge review once a research subject has completed corresponding visits at UNC Health facilities. The position will also meet with Principle Investigators/study teams to review the billing grid prior to study start up. These key research activities are a substantial part of the $1.3B UNC earns in Research activities across the University. This work impacts patients, faculty, staff, and all programs supported by these funds.

Position is Monday - Friday

Responsibilities

• Clinical Research Protocol Review: Review research protocols, sponsor agreements, informed consent forms and related documents. Analyze Medicare benefit policies, national and local coverage determinations, and review medical treatment guidelines related to study specific interventions and routine care. Create coverage analyses in accordance with Medicare's Clinical Trial Policy (NCD 310.1) and assist research staff within the clinical departments with the interpretation of related guidance and their effect on research billing processes.
• Apply the appropriate Hospital and/or CPT codes for potentially billable items in the coverage analysis to assist in the management of claims review, as well as identifying items that are to be billed to the sponsor via the budgeting and contract teams.
• Consultation on Research Billing Designations: Collaborate with the trial Principal Investigators and study team members to review any procedures that are not clear from the study documents and/or those representing a difference of coverage opinion. Work closely with the research team to conduct a thorough feasibility assessment using tools available.
• Consultation on Study Budgets: Assist in the creation of study budgets. Ensure that all treatment costs for clinical studies are included in the study budget and are appropriate and/or accurate. Assist audit and compliance departments during reviews and monitoring of clinical research billing.
• Document Preparation & Finalization: Provide clear documentation of the analysis that includes coverage determinations and supporting citations for the compliant and accurate categorization of all items and services.
• Healthcare Liaison: Serve as a liaison with the UNC Health Integrated Billing Office, identifying best practices and overseeing resolution of complex research billing issues. Work to resolve any billing questions from UNC Health Billing Office in a timely manner if a patient's record is on a bill hold.
• Other duties as assigned by management to meet business needs.

Other Information

Education Requirements

• Bachelor's degree or equivalent.

Licensure/Certification Requirements

None.

Professional Experience Requirements

• With a Bachelor's degree, requires one (1) year of related experience.
• With an Associate's degree, requires five (5) years of related experience.

Knowledge/Skills/and Abilities Requirements

None.

Job Details

Legal Employer: STATE

Entity: Shared Services

Organization Unit: Office of Clinical Research Operations

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: $31.04 - $44.62 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Remote

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: Yes

This is a State position employed by UNC Health Care System with UNC Health benefits. If, however, you are presently an employee of another North Carolina agency and currently participate in TSERS or the ORP, you will be eligible to continue participating in those plans at UNC Health.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation. UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email [e-mail] if you need a reasonable accommodation to search and/or to apply for a career opportunity.