Clinical Trials Coverage Analyst (Research Administration - Galveston)

About the position

The position provides centralized administrative review of clinical trial agreements, study protocols, informed consent documents, and budgets to ensure compliance with federal and state regulations for clinical research billing. The role involves determining the qualification of proposed clinical trials, assisting Principal Investigators and study coordinators in budget accuracy, and ensuring proper allocation of costs between routine and research expenses. The individual will also be responsible for generating billing grids, maintaining accounts receivable, and ensuring compliance with relevant guidelines.

Responsibilities

• Determine whether proposed clinical trials qualify as defined in all relevant national coverage decisions.
• Act as a resource and assist Principal Investigators, study coordinators, and budget analysts in ensuring all costs for clinical studies are included in the study budget and are appropriate and/or accurate.
• Determine the proper allocation of items and services between routine and research costs with input from principal investigators and study coordinators.
• Ensure budget worksheets identify appropriate billing parties and review financial agreements with contracts specialists.
• Ensure relevant sections of the informed consent document conform to CMS billing rules.
• Assist in mandatory training courses for faculty and personnel involved in clinical research when necessary.
• Coordinate the development of Standard Operating Procedures (SOPs) for all entities involved with clinical research billing.
• Assist in the development of monitoring plans for billing-related activities.
• Generate billing grids with applicable CPT and/or other codes in the Clinical Trial Management System.
• Remain knowledgeable and up to date with current FDA and Medicare guidelines for clinical trial billing.
• Maintain a complete portfolio of accounts receivable throughout the revenue cycle, including charge review, account work queues, claim edits, and claim submission.
• Review charges in Epic and Epic-generated reports to identify standard-of-care, research-related, or indeterminate services.
• Follow federal and state regulations to ensure compliance standards are met.
• Review research patient accounts to ensure research charges are routed appropriately.
• Communicate with Revenue Cycle teams, payors, and others to resolve account discrepancies or errors.
• Participate in meetings to address potential payor concerns.
• Adhere to internal controls and reporting structure.
• Perform related duties as required.

Requirements

• Bachelor's degree or equivalent
• Five years of related experience

Nice-to-haves

• Medical coding