Director, Clinical Research Billing

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

📋 Description

• Manage the clinical research billing framework, encompassing coverage analysis, clinical research budgets, calendars, research charge review, research charge master, and sponsor invoicing.

• Ensure financial sustainability by supporting sponsors and external collaborators.

• Create and execute thorough compliance programs for clinical research billing.

• Collaborate with Principal Investigators, study sponsors, study teams, finance/accounting, revenue cycle, internal audit, compliance, business office leaders, and clinic operations teams.

• Oversee the selection, scheduling, supervision, retention, evaluation, development, and mentorship of Clinical Research Billing staff.

• Conduct department meetings, performance evaluations, feedback sessions, coaching, corrective counseling, and recognition activities.

• Enhance team dynamics, team-building, and departmental process improvements.

• Lead the Clinical Research Billing Compliance Committee.

• Manage resources for research billing and coverage analysis, including internal and vendor resources.

• Review study calendars, coverage analyses, and study expenses.

• Supervise post-award revenue cycle activities, research charge review, patient care billing for clinical trials, revenue capture and reimbursement trends, and financial forecasting.

• Create policies, procedures, and workflows for clinical research billing.

• Achieve successful collection results against industry KPI and benchmark metrics.

• Collaborate with study teams, the School of Medicine, Revenue Cycle, Compliance, and Internal Audit.

• Oversee daily department operations, schedules, priorities, standards, and activities.

• Contribute to and manage training programs for clinical research revenue cycle participants.

• Implement and monitor compliance components involving coverage analysis, Epic Research Billing Charge Review, and OnCore Clinical Trial Management System.

• Design, manage, and conduct research billing compliance audits and utilize audit findings for education purposes.

• Address research billing non-compliance and work with Internal Audit and Business Practices on deficiencies and process enhancements.

• Maintain documentation and evidence of compliance for regulatory inspections and audits.

• Monitor changes in regulations, payer policies, the industry, Epic, and OnCore, and communicate implications to executive leadership.

• Ensure adherence to internal controls and provide quality assurance for research billing processes.

• Identify billing and coding inaccuracies and resolve process gaps with interdisciplinary teams.

• Optimize information systems, data management, analysis, and Epic research-related workflows.

• Apply lean principles to enhance processes.

• Collaborate with the School of Medicine to improve study activation through feasibility analysis, service identification/pricing, and pre-award budgeting.

• Ensure a safe and effective working environment while monitoring safety, accreditation, regulatory, infection control, and staff competency requirements.

• Develop and distribute training and educational materials with Revenue Cycle and School of Medicine training teams.

• Assist with departmental budgeting, expense management, staffing plans, schedules, and financial objectives.

• Ensure timely invoicing and payment of coverage analysis fees.

• Analyze clinical trial billing profit and loss and guide charge description master and fee schedules.

• Provide financial status reports to study teams and investigators.

• Lead workflow and practice modifications, Epic build/configuration input, change initiatives, and sustainable action plans.

• Build strategic relationships across teams, departments, and units.

• Identify and address developmental needs for both self and staff.

⛳️ Requirements

• Bachelor’s Degree in Business, Finance, Health Care Administration, or a related field.

• Eight (8) years of progressive management experience in clinical research operations.

• A minimum of five (5) years of progressive experience in research finance/billing compliance.

• Advanced knowledge of CMS billing rules and regulations, including National Coverage Determinations, Local Coverage Determinations, and Clinical Trial Policy (NCD 310.1).

• Strong understanding of the clinical research lifecycle, including coverage analysis, research charge review, budgeting, and sponsor invoicing.

• Advanced knowledge of CPT/HCPCS and healthcare terminology.

• Understanding of physician and hospital billing practices.

• Effective communication skills with patients, physicians, family members, and colleagues.

• Leadership, critical thinking, self-direction, initiative, interpersonal skills, and proficiency in oral and written communication.

• Capability to analyze data, identify issues and opportunities, draw conclusions, and formulate appropriate solutions.

• Ability to function effectively in a fast-paced environment.

• Flexibility and adaptability.

• Excellent analytical and interpersonal abilities.

• Sound judgment in applying and interpreting compliance policies, procedures, laws, rules, and regulations.

• Exceptional problem-solving skills and technical knowledge related to financial and clinical research billing challenges.

• Demonstrates necessary skills and competencies to safely perform assigned duties through ongoing evaluations and assessments.

• Must maintain required credentials demonstrating competency per the guidelines of accrediting agencies or department standards, as applicable.

• Must adopt and implement C-I-CARE standards for patients, families, and colleagues.

🏝️ Benefits

• Equal opportunity and non-discrimination in employment.

• Consideration of qualified applicants with criminal convictions following an individualized assessment.

• Employee patient and family experience framework and support.