Research Billing Coverage Analysis Coordinator

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. Applies 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 matter if a patient's record is on a bill hold
• Other duties as assigned by management to meet business needs

Benefits

• Remote work
• Glassdoor
• 3.7
• Not-for-profit integrated health care system serving North Carolina.
• Chapel Hill, North Carolina, USA
• https://www.unchealth.org
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Qualifications

• The ideal candidate for our Research Billing Coverage Analysis (BCA) Coordinator role is someone who thrives in a fast-paced clinical research environment and brings a strong understanding of research billing compliance, coverage analysis, and clinical trial operations
• This individual should be comfortable reviewing and interpreting complex research protocols, informed consent forms, sponsor agreements, Medicare benefit policies, and National and Local Coverage Determinations (NCDs and LCDs) to ensure compliant and accurate billing practices in accordance with the Medicare Clinical Trial Policy (NCD 310.1)
• Successful candidates have experience with clinical research billing workflows, coverage analysis calendars, budget development, and cross-functional collaboration with study teams, investigators, finance, and compliance stakeholders
• Familiarity with CTMS platforms such as OnCore, Epic, and other healthcare or research systems is highly valued, along with working knowledge of coding concepts (CPT/HCPCS) and clinical trial startup processes
• We're looking for someone who is highly detail-oriented, organized, and able to interpret ambiguous information while communicating clearly and effectively across teams
• Backgrounds in clinical research coordination, research administration, nursing or allied health, research finance, or healthcare revenue cycle operations are especially encouraged
• Bachelor's degree or equivalent
• With a Bachelor's degree, requires one (1) year of related experience
• With an Associate's degree, requires five (5) years of related experience
• With a Bachelor's degree, requires one (1) year of related experience.
• With an Associate's degree, requires five (5) years of related experience.

Required skills

• Budget Development, CPT/HCPCS Coding, Clinical Research Billing Workflows, Clinical Research Protocol Review, Clinical Trial Operations, Clinical Trial Startup, Coverage Analysis, Epic, Medicare Clinical Trial Policy (NCD 310.1), National and Local Coverage Determinations LCDs, National and Local Coverage Determinations NCDs, OnCore, Research Billing Compliance

Experience

• 1+ years