Description:

　　This position supports the research program in management post-award financial activities for research projects conducted for large community based hospital system. The primary function of the Research Billing Specialist is to review all research patient care items and services against a Medicare Coverage Analysis (MCA) and to segregate the charges by the applicable payor type. This role is based in the Central Research Department and supports multiple inpatient and outpatient practices. This role will manage research billing for oncology, cardiology, critical care and several other disease areas. This individual works closely with the Research Financial Analysts and Research Accountant.

　　PRIMARY DUTIES AND RESPONSIBILITIES:

　　Responsible for interpreting and applying to patient billing review.

　　Responsible for working with Patient Access, the Business Office and the Accounting and Finance Department to ensure that all research charges are identified and treated appropriately.

　　Track patient visits dates via the Clinical Trial Management System (CTMS) or multiple practice Electronic Medical Records.

　　Identify new research patient accounts in the financial system using reports from the CTMS and add appropriate patient flag.

　　Refer to study documents, such as the MCA, study protocol, informed consent form, Clinical Trial Agreement (CTA) and budget to review new research patient accounts for patient care charges associated with each clinical research project on a regular basis.

　　Credit and charge accounts to create clean insurance accounts and research only charge accounts.

　　Provide the hospital billing office and practice billing offices the appropriate modifiers and study information to be included on claims.

　　Ensure that professional fees are adjusted the same way that technical fees are adjusted.

　　Provide high quality customer service for patients enrolled on research studies by addressing questions or concerns about charges and following-up in a timely manner.

　　Address research billing questions from research team members and other staff.

　　Help educate research staff about the importance of regular and timely patient visit tracking as well as communication around study or patient status changes.

　　Ensure corrections or adjustments are communicated to the billing office in a timely manner.

　　Track overall bill hold amounts and ensure timely review and release of research accounts.

　　Complete month-end billing review and release.

　　Track when patients go off study and remove patient flag.

　　Work with billing quality assurance team to ensure compliant and timely billing review.

　　Prepare weekly report of research account standing.

　　Additional Skills & Qualifications:

　　Stay abreast of Medicare policy and regulatory documents to best inform the Medicare Coverage Analysis and patient care charge process.

　　Demonstrate effective professional communication.

　　Facilitate and model open communication among all staff involved in the conduct of clinical research.

　　Maintain confidentiality in all aspects of communication.

　　Foster professional presentation of verbal and written communications.

　　Stay abreast of sponsoring agency policy and regulatory documents.

　　Assist administration and management with the review, development and implementation of institutional policies and procedures to assist compliance with federal, state and local laws and regulations related to clinical research.

　　Other duties as assigned

　　Experience Level:

　　Intermediate Level

　　About Actalent

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