Manages and coordinates daily operations for clinical trial billing within the AHN Research Institute. Ensures compliant billing practices in accordance with federal, state and institutional regulations and standards for clinical trial billing ensuring all services for a study are billed properly. Requires ability to triage routine medical care and services or procedures conducted purely for research purposes following approved Medicare coverage analysis and code claims accordingly. Closely monitors staff assignments, productivity, EPIC and linical trial management system (CTMS) work queues, provides feedback, evaluation, and corrective action. Develops, maintains, and conducts training on clinical trial billing policies/practices and use of CTMS. Keeps Director informed of issues. Demonstrates knowledge of systems related to job responsibilities and assigned projects. Performs other duties as assigned.
- Manages daily operations of department to assure accuracy, timely review of research patient bills and ensures appropriate payor is being billed as defined by Medicare coverage analysis. Using auditing and analysis techniques, determines coding and billing of charges and concisely documents in the clinical trial management system (CTMS) the determinations made to support billing decisions. Reviews clinical documentation, coding and hospital and professional fee claim or charge information in accordance with study-specific tools to determine if the items and services provided to the patients enrolled in clinical research studies are to be billed to insurance or to the clinical study. Ensures that these costs are charged to the appropriate clinical trial cost center. (50%)
- Diagnoses and solves issues impacting clinical trial billing compliance. Works in close collaboration with the Medicare Coverage Analysts, Clinical Research Team, and the Professional and Hospital Revenue Cycle offices to achieve results by utilizing specialized billing expertise and communicating effectively in both written and verbal formats with staff, peers, all levels of management, and all encounters. (20%)
- Practices effective staff management to achieve desired departmental outcomes for operating results, employee job satisfaction, staff productivity, and leadership development. Supervises staff in a fair and consistent manner, evaluates work, and recommends and implements approved corrective actions. (10%)
- Serve as CTMS liaison and troubleshoots CTMS issues, develop/produces management reports from CTMS system related to visit completion/billing issues, maintains/monitors stipend cards inventory and oversees disbursements in accordance with established visit schedules, prepares monthly journal entries recording facility/profee revenue and charges to clinical trial cost center. (10%)
- Maintains current knowledge of clinical trial billing in accordance with federal, state and institutional regulations and standards, develops sound practices/policies and train accordingly. (10%)
- BA or BS degree.
- Experience with ICD-10 and CPT Coding.
- 5-7 years’ prior job related experience.
- 3 years of experience with Medicare coverage analysis, medical billing and collections, revenue cycle and/or experience with clinical trial billing.
- Strong organizational, problem-solving, and analytical skills.
- Proficient with Excel and computer skills.
- Experience with Charge Description Master (CDM.)
- Healthcare experience with understanding of Medicare billing rules and functional knowledge of essential National Coverage Decisions and Local Coverage Decisions.
- Knowledge of medical terminology, pharmacology, disease processes, surgical and medical procedures.
- Experience with EPIC and/or clinical trial management system desired.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org