This position is responsible for supervising, coordinating and administering research feasibility, finance and billing compliance for all studies throughout (institution and health care system).This position will ensure compliance with regulatory policies and procedures related to billing compliance. The Coordinator is expected to ensure accurate billing for patients enrolled in clinical trials in accordance with federal regulations to reduce both institutional and individual provider legal and financial risks. The Coordinator will work collaboratively with all process owners to educate and ensure documentation which supports compliant research billing practices. This position will be required to complete the Medicare Coverage Analysis for any new research projects under consideration. Responsibilities for negotiations and analysis of sponsor agreements would also be included in this role.
Bachelorâs degree in business, finance, hospital/health care administration, or related field. Masterâs degree in health administration or business administration preferred.
Three to five years of recent work experience in finance, accounting, or clinical research compliance and billing.
Required to have basic working knowledge of medical terminology, ICD-10, CPT, HCPCS, DRG, APC, FDA, Office of Human Research Protection, revenue and charge master codes and expected to become an expert within one year.
Demonstrated knowledge of applicable regulations governing research billing compliance.
Reports to the Director of Reimbursement
AGE OF PATIENTS SERVED
Cares for patients in the age category(s) checked below:
X_No direct clinical contact with patients
ESSENTIAL DUTIES AND RESPONSIBILITIES
Supports the Mission, Vision and Values of Munson Healthcare
Has basic understanding of Relationship-Based Care (RBC) principles, meets expectations outlined in
Commitment To My Co-workers, and supports RBC unit action plans.
Embraces and supports the Performance Improvement philosophy of Munson Healthcare.
Promotes personal and patient safety.
Uses effective customer service/interpersonal skills at all times.
Implements patient tracking system to ensure all invoices are billed appropriately and track every protocol subjectâs bills.
Facilitates research project feasibility review and approval process.
Oversees and conducts Medicare Coverage Analysis on all clinical research projects to determine appropriate payer source for clinical trial services applying coverage rules to develop budget justification in the trial budget.
Oversees and conducts budget development for clinical research projects.
Develops and oversees protocols and procedures for charging, billing and collection of payments for research studies across Munson Healthcare system.
Creates reports for clinical research staff to review reducing customer service issues by correctly identifying charges that are trial related.
Performs research fund account reconciliation.
Assists in the analysis of processes and recommend changes and/or modifications to meet compliance and customer service goals.
Collaborates with Research and Compliance on complex issues to provide physicians and other billing staff with complete and accurate billing compliance guidance.
Participates in continuing education to keep updated on new rules, regulations and revisions, as set forth by the Center for Medicare and Medicaid Services (CMS) and other entities regarding billing compliance.
Provides technical assistance for the auditing processes, standards and quality of the audit work product generated by compliance audit team.
Establishes and maintains a professional working relationship with Patient Financial Services, Access Services, research, medical staff members, Compliance and Internal Audit Department, and external participants involved with the process to ensure accurate documentation, coding, charging and billing for all services provided related to research or clinical trial billing.
Develops and delivers reports, as requested to assist in the analysis of billing compliance patterns throughout the health system.
Displays adequate proficiency with Excel, Outlook, Work, PowerPoint, and other computer systemsâ that will need to be used to audit and monitor appropriately.
Collaborates with legal department on contract development, review and execution.
Verifies appropriate Institutional Review Board review and approval.
Performs other duties as assigned.
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