Research Coverage Analyst I

Baylor Scott & White Health; Dallas (TX); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health benefits

401(k) match

Tuition reimbursement

PTO starting Day 1

Job summary

Baylor Scott & White Health in Dallas seeks a Research Billing Compliance Specialist to oversee Medicare coverage review processes, build billing grids, and ensure all billing practices comply with Medicare policies.

You will collaborate with healthcare providers and billing departments, stay current with regulatory changes, and prepare detailed reports to support coverage determinations and appeals.

Ideal candidates have strong Excel skills and at least two years of relevant experience.

Qualifications

• Minimum 2 years of experience in research billing compliance.
• Proficient in Excel, Word, PowerPoint and databases.
• Ability to collaborate with multiple departments.
• Strong customer service orientation and communication skills.
• Ability to read and interpret complex scientific/medical text.

Responsibilities

• Conducts examination of Medicare coverage policies and guidelines.
• Builds billing compliant coverage examination grids.
• Reviews and interprets research protocols and billing guidelines to establish coverage eligibility.
• Collaborates with healthcare providers and billing departments for accurate billing practices.
• Stays up to date with changes in Medicare regulations and communicates updates.
• Prepares detailed reports to support coverage determinations and appeals.

Skills

Team collaboration

Customer service

Attention to detail

Reading comprehension

Education

Bachelor's degree

Tools

Microsoft Excel

Microsoft Word

PowerPoint

Database applications

Internet search engines

Job description

About Us

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott & White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

Our Core Values Are

• We serve faithfully by doing what's right with a joyful heart.
• We never settle by constantly striving for better.
• We are in it together by supporting one another and those we serve.
• We make an impact by taking initiative and delivering exceptional experience.

Benefits

• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level.

Job Summary

The ideal candidate will know Research Billing Compliance and create Medicare coverage REVIEW billing grids. Maintaining billing compliance is crucial. It ensures all billing practices follow Medicare policies and regulations. This prevents errors and potential penalties. A solid understanding of Medicare policies and regulations is essential for precise and compliant billing practices.

Essential Functions Of The Role

• Conducts comprehensive examination of Medicare coverage policies and guidelines.
• Builds billing compliant coverage examination billing grids.
• Reviews and interprets research protocols, practice and billing guidelines, and other pertinent documentation to establish Medicare coverage eligibility.
• Collaborates with healthcare providers and billing departments to ensure accurate and compliant billing practices.
• Stays up to date with changes in Medicare regulations and communicates updates to relevant departments.
• Prepares detailed reports and documentation to support coverage determinations and appeals.

Key Success Factors

• Minimum of two years of experience in research billing compliance, research budgeting/contracting, research clinical or medical billing.
• Ability to effectively collaborate with multiple departments. Proven ability to work in a team environment, using electronic resources and communication.
• Ability to provide quality customer service. Ability to interact with faculty, staff, departments, and external collaborators and business entities.
• Proven ability to work alone and respond quickly. Self-motivated, able to handle multiple projects and tasks, prioritizing well. Exceptional organizational skills with outstanding attention to detail.
• Ability to quickly read and comprehend large amounts of electronic text comprised of scientific, medical, and legal language.
• Advanced skills in using software like Microsoft Excel, Word, PowerPoint, database applications, and internet search engines. Ability to learn new systems easily.

Belonging Statement

We believe that all people should feel welcomed, valued and supported.

Qualifications

• EDUCATION - Bachelor's
• EXPERIENCE - 2 Years of Experience