Position Summary / Career Interest:

Responsible for the coordination and creation of a coverage analyses for all clinical trials in accordance with the Center for Medicare and Medicaid Services (CMS) regulations and institutional policies, and responsible for the creation of a clinical trial billing matrix to be used to determine appropriate payors and responsible parties for charges.

Responsibilities and Essential Job Functions

• Creates coverage analysis grids and analyzes the performance of the actual coverage analysis, using CMS regulations, FDA guidance, Good Clinical Practice guidelines, and ethical policies when performing coverage analyses
• Researches and applies policies, guidance, and guidelines from various sources including federal and state regulatory agencies and The University of Kansas Hospital policies
• Responsible for the dissemination of relevant documents and information to various parties
• Performs basic and complex billing and budget analysis in accordance with CMS regulations for all clinical trials performed at The University of Kansas Hospital and affiliates
• Serves as liaison to the budget & financial analysts at the KUMC Research Institute and the KU Cancer Center Clinical Trials Office, collaborating closely to ensure that the clinical trial budget, coverage analysis, and billing matrix are all consistent and appropriate
• Develops billing matrices and coverage analyses including reviewing each potentially billable item within the clinical trial and citing specific resources for the justification of appropriate designations
• Applies the appropriate CDM and CPT code for potentially-billable items in the coverage analysis in order to assist Patient Financial Services in the management of claims review, as well as identifying items that are to be billed to the study sponsor by the KUMC Research Institute
• Assists as needed with claims review in distinguishing research charges billed to the study versus those that may be billed to insurance payors.
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

• High School Graduate
• 3 or more years of experience in Clinical Research Billing and/or Billing Compliance.
• 2 or more years of experience in Budgeting and Medicare Coverage Analysis Development.

Preferred Education and Experience

• Bachelors Degree in related field from an accredited college or university.
• Epic experience.
• Experience with electronic Clinical Trial Management Systems.

Preferred Licensure and Certification

• Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC)

Preferred Language Skills

• English

Knowledge Requirements

• A demonstrated understanding of Research Billing Compliance including National Coverage Determination for coverage of routine costs and the CMS Clinical Research Policy.
• A demonstrated knowledge of regulatory, financial and administrative requirements of Medicare and third party billing of clinical trials - Proficient in Excel, Word, PowerPoint.
• Proficiency in Medical Terminology.

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.