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Research Medicare Coverage Analysis Specialist
Cleveland Clinic. Determine qualifying clinical trial status and perform detailed coverage analyses in accordance with NCD 310.1 and the Federal Clinical Trials Policy .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medicare Coverage Analysis, clinical trial protocols, and compliance with federal and state regulations. Proficient in billing processes, documentation, and collaboration with research teams and stakeholders.
Highest-signal resume keywords
Medicare Coverage AnalysisClinical Trial Protocol ReviewResearch Billing ComplianceFDA Regulations KnowledgeCommunication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Clinical Trial AgreementsInformed Consent DocumentsCPT CodingCoverage DeterminationsBudget AnalysisOperational Efficiency ImprovementClaims ReviewPatient Care Item AssessmentRegulatory Document ReviewFederal Clinical Trials Policy
Soft Skills
Oral CommunicationWritten CommunicationTime ManagementInterpersonal SkillsProblem-Solving
Industry Keywords
Healthcare AdministrationClinical ResearchComplianceResearch SponsorsCMS GuidelinesNCD 310.1Clinical Research BillingStudy BudgetsPrincipal InvestigatorsIRB
About the role
Key responsibilities & impact- Determine qualifying clinical trial status and perform detailed coverage analyses in accordance with NCD 310.1 and the Federal Clinical Trials Policy
- Review clinical trial protocols, regulatory documents, clinical trial agreements, informed consent documents, FDA and CMS documents, and study budgets
- Assess all patient care items and services required by study protocols
- Determine final billing designations for procedures within clinical research projects
- Establish and support the centralized Medicare Coverage Analysis Office
- Standardize Medicare Coverage Analysis processes and improve operational efficiency
- Research and apply federal, state, CMS, and professional practice guidelines in coverage determinations
- Document coverage analysis justifications with specific supporting resources
- Assist with claims review by applying appropriate CDM and/or CPT codes
- Identify items and services billable to research sponsors
- Collaborate with Principal Investigators, research teams, patient financial services, clinical research billing, IRB, and research compliance
- Maintain current knowledge of FDA and Medicare regulations and applicable state laws
- Assist the MCA Director with tools and billing grids for the Medicare Coverage Analysis process
- Perform other duties as assigned
Requirements
What you’ll need- Bachelor’s degree in Healthcare Administration, Medical Coding, Auditing, Finance, Accounting, Nursing or a related field and four years of relevant experience in research billing, compliance, and/or direct involvement with sponsored clinical trials
- In lieu of degree, six years of relevant experience in research billing, compliance, and/or direct involvement with sponsored clinical trials
- Excellent oral and written communication skills
- Ability to effectively communicate with the Principal Investigator, research team, central offices and study Sponsor
- Ability to interpret and comprehend complex clinical research protocols
- Ability to interpret research contracts, study budgets and consent forms to extrapolate billing/coverage data
- Ability to manage high volume workload and meet required deadlines
- Ability to perform work in a stationary position for extended periods
- Ability to operate a computer and other office equipment
- Ability to communicate effectively and exchange accurate information
- Ability to travel throughout the health system
- Compliance with annual influenza vaccination program or approved exemption
- Successful controlled-substance testing following an offer of employment
Benefits
Comp & perks- Annual influenza vaccination or approved exemption required
- Drug-free workplace with controlled-substance testing following offers of employment
- Equal employment opportunity