Trials Coverage Analyst, Research Administration (Galveston)

EDUCATION & EXPERIENCE

Minimum Qualifications:

• Bachelor’s degree or equivalent, five years of related experience

Preferred Qualifications:

• Medical coding

JOB SUMMARY

Provides centralized administrative review of clinical trial agreements, study protocols, informed consent documents, and budgets to ensure Principal Investigators and other billing entities comply with federal and state regulations for clinical research billing.

Scope: NA

ESSENTIAL JOB FUNCTIONS

• Determine whether proposed clinical trials qualify as defined in all relevant national coverage decisions.
• Acts as a resource and assists Principal Investigators, study coordinators, and budget analysts in determining that all costs for clinical studies are included in the study budget and are appropriate and/or accurate.
• With input from the principal investigators and study coordinators, the proper allocation of items and services between routine and research costs is determined, and methods are set up to bill accordingly. This responsibility includes the following tasks: ensuring budget worksheets identify appropriate billing parties, reviewing financial agreements with UTMB contracts specialists and, if necessary, collaborating entities, and ensuring financial consistency between research agreements and study protocols.
• Ensures that relevant sections of the informed consent document conform to CMS billing rules.
• Assists in mandatory training courses for faculty and personnel involved in clinical research when necessary.
• Coordinates the development of Standard Operating Procedures (SOPs) for all entities involved with clinical research billing.
• Assists in the development of monitoring plans for billing-related activities.
• Generates billing grids with applicable CPT and/or other codes in the Institution’s Clinical Trial Management System.
• Remains knowledgeable and up to date with current FDA and Medicare guidelines for clinical trial billing
• Maintains a complete portfolio of accounts receivable throughout the revenue cycle, including charge review, account work queues, claim edits, and claim submission.
• Reviews charges in Epic and Epic-generated reports to identify standard-of-care, research-related, or indeterminate services.
• Follows federal and state regulations to ensure compliance standards are met.
• Review research patient accounts to ensure research charges are routed appropriately.
• Communicate with Revenue Cycle teams, payors, and others to resolve account discrepancies or errors;
• Participates in meetings, as needed, to address potential payor concerns
• Other duties as assigned

Marginal or Periodic Functions:

• Adheres to internal controls and reporting structure.
• Performs related duties as required.

KNOWLEDGE/SKILLS/ABILITIES

• Working knowledge of Epic and OnCore systems
• Communication skills
• Problem-solving skills
• Critical Thinking

Salary Range:

Commensurate with experience.

EQUAL EMPLOYMENT OPPORTUNITY:

UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.