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, research budgets, calendars, research charge review, research charge master, and sponsor invoicing.

• Provide effective, compliant, and innovative support for the research community.

• Design and execute comprehensive compliance programs for clinical research billing.

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

• Oversee departmental staff, schedules, operations, priorities, standards, and activities.

• Select, supervise, retain, evaluate, mentor, and develop team members.

• Conduct department meetings, performance evaluations, coaching, recognition, and employee engagement initiatives.

• Facilitate team-building and process enhancement efforts.

• Lead the Clinical Research Billing Compliance Committee.

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

• Review study calendars, coverage analysis, and study-related expenses.

• Supervise post-award revenue cycle activities, clinical trial patient-care billing, revenue capture, reimbursement trends, and financial forecasting.

• Create policies, procedures, workflows, training programs, and educational materials.

• Achieve collection results in alignment with industry KPIs and benchmarks.

• Develop and sustain compliance programs covering coverage analysis, budget reconciliation, calendars, charge review, and invoicing.

• Implement and supervise Epic Research Billing Charge Review and OnCore Clinical Trial Management System components.

• Manage audits related to research billing compliance and utilize audit findings to enhance education.

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

• Prepare the organization for regulatory inspections and audits.

• Track changes in regulations, payer policies, industry standards, Epic, and OnCore, and communicate their effects to executive leadership.

• Maintain internal controls and ensure quality assurance.

• Identify billing and coding discrepancies and collaborate with interdisciplinary teams to address process gaps.

• Optimize information systems, data management, and analysis; implement lean principles.

• Collaborate with the School of Medicine regarding study activation, feasibility, pricing, and pre-award budgeting.

• Ensure compliance with workplace safety, infection control, accreditation, regulatory standards, and staff credentialing requirements.

• Assist with departmental budgets, expenses, staffing plans, financial targets, profit and loss analysis, charge description master, and fee schedules.

• Provide financial status updates to study teams and investigators.

• Drive workflow and practice modifications, including the Epic research module build/configuration.

• Build strategic relationships and identify development needs for 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.

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

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

• Strong comprehension of the clinical research lifecycle, particularly in coverage analysis, research charge review, budgeting, and sponsor invoicing.

• Advanced knowledge of CPT/HCPCS and healthcare terminology.

• Understanding of physician and hospital billing practices.

• Skills and competencies required to safely perform the assigned duties.

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

• Strong leadership, critical thinking, self-direction, initiative, interpersonal, oral, and written communication skills.

• Ability to analyze data from various sources, identify issues and opportunities, draw conclusions, and develop suitable solutions.

• Capacity to work efficiently 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, creativity, adaptability, resourcefulness, timeliness, and technical expertise.

• Maintain necessary credentials demonstrating competency, as applicable.

🏝️ Benefits

• Opportunities for employee selection, scheduling, supervision, retention, evaluation, development, and mentoring.

• Training and educational opportunities.

• Equal opportunity employment and commitment to non-discrimination.

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

• Day shift schedule: 08 hours.