Senior Medicare Coverage Analyst (Remote) - Trial Billing Expert

MFS Investments; Boston (MA); Hybrid; USD 78,000 - 90,000; Full time

Job summary

Dana-Farber Cancer Institute is hiring a Medicare Coverage Analyst to review protocols and documents, create coverage analyses, and determine qualifying trials per Medicare policy. The Senior MCA will mentor junior staff and act as a subject matter expert on LCD and NCD policy.

The role requires a bachelor's or RN, 5 years in Medicare coverage analysis, and CTMS experience. It is remote with occasional onsite requirements in Boston, MA, and offers opportunities to influence budgeting and study

Qualifications

• 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

Responsibilities

• 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

Skills

Research activity knowledge

Billing compliance knowledge

Medicare regulations/policy

CTMS knowledge

Communication with study teams

Education

Bachelor's degree or RN credential

Tools

CTMS

Job description

Dana-Farber Cancer Institute is hiring a Medicare Coverage Analyst to review protocols and documents, create coverage analyses, and determine qualifying trials per Medicare policy. The Senior MCA will mentor junior staff and act as a subject matter expert on LCD and NCD policy.

The role requires a bachelor's or RN, 5 years in Medicare coverage analysis, and CTMS experience. It is remote with occasional onsite requirements in Boston, MA, and offers opportunities to influence budgeting and study