Clinical Research Billing Coverage Analyst

Job Description

ECU Health

About ECU Health

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children's Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

Position Summary

The Billing Coverage Analyst will play a pivotal role in the daily operations of managing billing compliance for clinical research studies at ECU and ECU Health. Working in close collaboration with study sponsors, clinical units, research teams, and regulatory affairs offices, this team member will be responsible for conducting comprehensive financial reviews.

Managing a portfolio of studies, the Billing Coverage Analyst will provide crucial support to investigators, clinical staff, and patients by ensuring adherence to billing regulations and overseeing financial aspects related to the studies. Responsibilities include interpreting study protocols and contracts, communicating effectively with internal and external stakeholders, maintaining detailed documentation, and contributing to the development of billing compliance policies and procedures. The position requires a keen understanding of billing regulations, strong analytical skills, and the ability to collaborate across diverse teams to uphold the financial integrity of research programs. Other duties include supporting audits, providing training on billing compliance, and contributing to continuous process improvement.

Responsibilities

1.Coverage Analysis:

Conduct comprehensive coverage analyses for clinical research studies to determine billable items and services.

Review and interpret study protocols, contracts, and billing agreements to assess billing compliance.

2.Regulatory Compliance:

Stay abreast of federal, state, and local regulations related to research billing and ensure adherence to billing guidelines.

Work closely with regulatory affairs teams to understand and implement changes in billing regulations.

3.Communication and Collaboration:

Collaborate with principal investigators, research coordinators, and finance teams to gather necessary information for accurate billing.

Communicate effectively with internal and external stakeholders to resolve billing discrepancies and address queries.

4.Documentation and Record Keeping:

Maintain organized and detailed documentation of coverage analyses, ensuring that all supporting materials are easily accessible.

Assist in the development and maintenance of billing compliance policies and procedures.

Other duties as assigned.

5.Training and Education:

Provide training sessions to research staff on billing compliance and coverage analysis processes.

Stay informed about industry best practices and share knowledge with the team to enhance overall understanding.

6.Audit Support:

Assist in internal and external audits related to research billing, providing necessary documentation and information.

Identify and implement corrective actions based on audit findings to improve billing processes.

Minimum Requirements

Bachelors Degree in finance, healthcare, administration, or a related field is required.

Masters Degree preferred, MBA or Masters in Healthcare Administration.

3 - 4 years experience in clinical research finance, billing compliance, or financial auditing required.

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant's qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.

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