Research Coverage Analyst I

Baylor Scott & White Health; Highland Park (TX); On-site; USD 55,000 - 85,000; Full time

Benefits offered by this job

Health benefits

401(k) match up to 5%

Tuition reimbursement

PTO Day 1

Job summary

Baylor Scott & White Health is seeking a Research Billing Compliance Specialist to ensure Medicare coverage review and billing grids are compliant and accurate. The role requires building billing grids, interpreting research protocols and guidelines, and coordinating with revenue cycle teams to prevent errors and penalties while maintaining regulatory alignment.

Ideal candidates will have at least two years of related experience and the ability to read complex clinical and legal text, with

Qualifications

• Bachelor's degree required.
• Minimum two years of experience in research billing compliance.
• Experience with research budgeting/contracting and medical billing.

Responsibilities

• 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 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.

Skills

Billing compliance

Medicare policies

Education

Bachelor's

Job description

About Us

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and 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

Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

• 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

As a health care system committed to improving the health of those we serve, we are asking our employees to model the same behaviours that we promote to our patients. As of January 1, 2012, Baylor Scott & White Health no longer hires individuals who use nicotine products. We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.