Research Medicare Coverage Analysis Specialist

This is a fully remote position, open to applicants in Florida, +2 more states.

📋 Description

• Evaluate the eligibility of clinical trials and conduct comprehensive coverage analyses according to NCD 310.1 and the Federal Clinical Trials Policy.

• Examine clinical trial protocols, regulatory documents, agreements, informed consent forms, FDA and CMS documentation, and study budgets.

• Analyze patient care items and services as mandated by study protocols.

• Establish final billing classifications for procedures involved in clinical research projects.

• Ensure adherence to research billing regulations.

• Investigate and implement federal, state, CMS, and professional practice guidelines for coverage decisions.

• Record justifications for coverage analyses with referenced resources.

• Support claims review by utilizing appropriate CDM and/or CPT coding.

• Identify items and services eligible for billing to research sponsors.

• Collaborate with Principal Investigators, research teams, patient financial services, the clinical research billing office, IRB, and research compliance.

• Stay updated on FDA and Medicare regulations, as well as relevant state laws.

• Assist the MCA Director in creating tools and billing grids.

• Undertake other assigned duties.

⛳️ Requirements

• Bachelor’s degree in Healthcare Administration, Medical Coding, Auditing, Finance, Accounting, Nursing, or a related field.

• Alternatively, six years of relevant experience in research billing, compliance, or direct involvement with sponsored clinical trials.

• A minimum of four years of relevant experience in research billing, compliance, or direct involvement with sponsored clinical trials.

• Capability to interpret and understand complex clinical research protocols, contracts, study budgets, and consent forms to extract billing/coverage information.

• Strong organizational abilities with the capacity to manage multiple tasks.

• Preferred: Proficiency in navigating the CMS website.

• Preferred: Experience in coding.

• Preferred: Background in science or healthcare (e.g., Billing, clinical trials).

• Ability to work in a stationary position for extended durations.

• Proficient in operating a computer and other office equipment.

• Effective communication skills for accurate information exchange.

• Willingness to travel across the health system.

• Compliance with personal protective equipment requirements as applicable.

🏝️ Benefits

• Annual influenza vaccination or an approved exemption is mandatory.

• Commitment to equal opportunity employment.

• A drug-free workplace policy.

• Controlled-substance testing is conducted following employment offers.