Clinical Trial Budget Analyst

This is a fully remote position, open to applicants in California.

📋 Description

• Assess whether a study qualifies as a clinical trial.

• Conduct initial coverage analysis by examining protocol clinical services to ensure compliance with federal billing and reimbursement regulations.

• Guarantee the thorough submission of documents necessary to perform coverage analysis and initiate studies.

• Send participation notification letters to Noridian when necessary.

• Identify and document billing support for clinical items by reviewing protocols, investigator brochures, sponsor budgets, sponsor contracts, consent templates, medical necessity justifications, and relevant payers.

• Implement federally mandated research-related claims modifications for insurance reimbursement.

• Perform a final review and analysis of study documents to ensure consistency.

• Interpret coverage decisions by Medicare/Medicaid, national guidelines, and relevant rules for medical items and services in clinical trials.

• Assist with CPT/HCPCS billing decisions for clinical trial items and services.

• Apply local and national coverage determinations along with third-party payer regulations.

• Collaborate with Sutter Health research affiliates, administrative personnel, principal investigators, key partners, and clinical trial sponsors concerning reimbursement matters.

• Establish a unified support function to standardize administrative and financial assistance for clinical trial billing compliance.

• Enhance services for the Sutter Health research community and boost research compliance.

⛳️ Requirements

• Bachelor's degree or equivalent education/experience.

• 5 years of recent relevant experience.

• Understanding of clinical research concepts, good clinical practices, and regulatory compliance.

• Familiarity with Medicare benefit categories, statutory exclusions, national and local coverage determinations, and national medical practice guidelines.

• Knowledge of Food and Drug Administration investigational drug and device research.

• Proficiency in medical coding, protocol visit span allowances, protocol-specified clinical services, and financial activities and documentation in clinical research.

• Experience with research protocols, internal budgets, sponsor contracts and budgets, and consent templates.

• Proven written, verbal, electronic communication, presentation, and interpersonal skills.

• Capability to utilize multiple technical systems.

• Ability to collaborate across revenue cycle, compliance, and research operations teams.

• Strong attention to detail.

• Analytical and computer skills, including proficiency in Microsoft Word, Outlook, and Excel.

• Ability to work independently and make complex, sensitive decisions.

• Exceptional organizational skills to manage competing schedules and responsibilities.

• Demonstrated leadership abilities, including team building and mentoring/coaching.

• Capacity to develop effective working relationships with employees, peers, and leaders.

• Strong organizational and time management skills.

• Ability to prioritize multiple projects while delivering quality service and achieving business objectives.

• Tactical and analytical thinking and planning skills.

• Aptitude for developing plans, identifying obstacles, and resolving operational challenges.

• Proficiency in communicating and collaborating with Sutter Health essential partners and research institute personnel.

🏝️ Benefits

• Comprehensive benefits package.

• Eligible positions come with a complete benefits package.