Research Billing Specialist - Baystate Health
Springfield, MA
About the Job
Location: Chestnut Street; Springfield MA
Schedule: Monday-Friday 8a-430pm
Hybrid Option: First 90 days onsite and once probationary period is complete 3 days in office and 2 remote.
Job Responsibilities:
1) Analyze and review any hospital and/or professional charges for clinical trials generated across all hospital ordering systems to make determinations on charge segregation of items and services using the Medicare coverage analysis billing grid (MCA) and other medical documentation.
2) Examines and evaluates research related charges for appropriate and consistent routing to the appropriate payor (sponsor or third-party vendors).
3) Provides consistent reporting and charge information as needed to Clinical Trials Office and Sponsored Programs Administration.
4) Works closely with Patient Accounting to ensure insurance claims identify research participation in accordance with Medicare (CMS) billing rules and institutional policies.
5) Responsible for identifying variances between the hospital and professional billing entries against required charge routing based on the MCA.
6) Escalates any discrepancies in standard of care versus research charges to the appropriate clinical team/provider to ensure accurate charge routing.
7) Interprets coverage analysis information and enters important details to provide an audit trail for further review.
8) Evaluates instances of non-compliance and communicates research billing/coding integrity deficiencies as applicable to [Billing Compliance Office].
9) Assists in investigating and resolving research billing/coding deficiencies uncovered in an audit, or in an ad-hoc for-cause review. Assists in follow up and resolution, including completion of corrective actions.
10) Maintains an up-to-date understanding of Medicare’s Clinical Trial Policy (NCD 310.1) and newly issued guidance, FDA regulations, and applicable federal and state statutes.
11) Assists in educating principal investigators-study teams regarding compliance with government regulations with special attention to CMS guidelines as they pertain to billing for patients enrolled in clinical trials.
12) Provides feedback to coverage analysis and budget development teams as needed on charge CPT codes to ensure prices are accurate for research related charges.
13) Maintain confidentiality in all aspects of communication.
14) Assist in reporting and trend evaluation as needed.
15) Perform other duties as required or assigned.
Required Experience:
A minimum of 3 years of experience in a healthcare or clinical setting is required.
Preferred Expereince:
Experience and knowledge regarding Medicare, Medicaid, and/or commercial payer benefits is preferred, along with previous utilization of systems such as OnCore, Cerner, and Sorian.
Familiarity with research billing, or research billing compliance a significant plus.
Working knowledge and experience with clinical trial regulatory documents such as protocols, informed consent documents and Clinical Trial Agreements (CTA).
Skills/Competencies:
Strong competency in Microsoft Excel and Word required.
Knowledge of regulatory requirements for research related billing
Knowledge of OnCore, Cerner, and Sorian preferred.
Effective organizational skills with strong attention to detail.
Effective interpersonal and communication skills desired.
Knowledge of regulations regarding the use of human subjects in clinical trials, outcomes research, nursing research, and other research areas is preferred.
You Belong At Baystate
At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.
DIVERSE TEAMS. DIVERSE PATIENTS. DIVERSE LOCATIONS.
Education:
High School Diploma (Required)
Certifications:
Equal Employment Opportunity Employer
Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.
Schedule: Monday-Friday 8a-430pm
Hybrid Option: First 90 days onsite and once probationary period is complete 3 days in office and 2 remote.
Job Responsibilities:
1) Analyze and review any hospital and/or professional charges for clinical trials generated across all hospital ordering systems to make determinations on charge segregation of items and services using the Medicare coverage analysis billing grid (MCA) and other medical documentation.
2) Examines and evaluates research related charges for appropriate and consistent routing to the appropriate payor (sponsor or third-party vendors).
3) Provides consistent reporting and charge information as needed to Clinical Trials Office and Sponsored Programs Administration.
4) Works closely with Patient Accounting to ensure insurance claims identify research participation in accordance with Medicare (CMS) billing rules and institutional policies.
5) Responsible for identifying variances between the hospital and professional billing entries against required charge routing based on the MCA.
6) Escalates any discrepancies in standard of care versus research charges to the appropriate clinical team/provider to ensure accurate charge routing.
7) Interprets coverage analysis information and enters important details to provide an audit trail for further review.
8) Evaluates instances of non-compliance and communicates research billing/coding integrity deficiencies as applicable to [Billing Compliance Office].
9) Assists in investigating and resolving research billing/coding deficiencies uncovered in an audit, or in an ad-hoc for-cause review. Assists in follow up and resolution, including completion of corrective actions.
10) Maintains an up-to-date understanding of Medicare’s Clinical Trial Policy (NCD 310.1) and newly issued guidance, FDA regulations, and applicable federal and state statutes.
11) Assists in educating principal investigators-study teams regarding compliance with government regulations with special attention to CMS guidelines as they pertain to billing for patients enrolled in clinical trials.
12) Provides feedback to coverage analysis and budget development teams as needed on charge CPT codes to ensure prices are accurate for research related charges.
13) Maintain confidentiality in all aspects of communication.
14) Assist in reporting and trend evaluation as needed.
15) Perform other duties as required or assigned.
Required Experience:
A minimum of 3 years of experience in a healthcare or clinical setting is required.
Preferred Expereince:
Experience and knowledge regarding Medicare, Medicaid, and/or commercial payer benefits is preferred, along with previous utilization of systems such as OnCore, Cerner, and Sorian.
Familiarity with research billing, or research billing compliance a significant plus.
Working knowledge and experience with clinical trial regulatory documents such as protocols, informed consent documents and Clinical Trial Agreements (CTA).
Skills/Competencies:
Strong competency in Microsoft Excel and Word required.
Knowledge of regulatory requirements for research related billing
Knowledge of OnCore, Cerner, and Sorian preferred.
Effective organizational skills with strong attention to detail.
Effective interpersonal and communication skills desired.
Knowledge of regulations regarding the use of human subjects in clinical trials, outcomes research, nursing research, and other research areas is preferred.
You Belong At Baystate
At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.
DIVERSE TEAMS. DIVERSE PATIENTS. DIVERSE LOCATIONS.
Education:
High School Diploma (Required)
Certifications:
Equal Employment Opportunity Employer
Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.
Source : Baystate Health