Research Medicare Coverage Analysis Specialist

Cleveland Clinic

. Determine qualifying clinical trial status and perform detailed coverage analyses under NCD 310.1 and the Federal Clinical Trials Policy .

Posted 11/6/2026full-timeRemote • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical trial billing compliance, including coverage analysis and interpretation of complex research protocols. Proficient in applying federal and state regulations, coding practices, and collaborating with research teams to ensure accurate billing and compliance.

Highest-signal resume keywords

Clinical Trial Billing ComplianceCoverage AnalysisResearch Protocol InterpretationCoding ExperienceRegulatory Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Trial Protocol ReviewCoverage DeterminationBilling DesignationCPT CodingBudget AnalysisRegulatory Document ReviewClaims ReviewResearch ComplianceFederal Regulations KnowledgeCMS Guidelines Application

Soft Skills

Strong Organizational SkillsEffective CommunicationMulti-tasking Ability

Tools & Technologies

CMS Website NavigationOffice Equipment Operation

Industry Keywords

Healthcare AdministrationMedical CodingClinical TrialsResearch BillingCompliance

About the role

Key responsibilities & impact

Determine qualifying clinical trial status and perform detailed coverage analyses under 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 patient care items and services required by study protocols
Determine final billing designations for procedures within clinical research projects
Ensure compliant research billing practices
Research and apply federal, state, CMS, and professional practice guidelines for coverage determinations
Document coverage-analysis justifications with cited 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 office, IRB, and research compliance
Maintain current knowledge of FDA and Medicare regulations and applicable state laws
Assist the MCA Director in developing tools and billing grids
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
In lieu of degree, six years of relevant experience in research billing, compliance, and/or direct involvement with sponsored clinical trials
Four years of relevant experience in research billing, compliance, and/or direct involvement with sponsored clinical trials
Ability to interpret and comprehend complex clinical research protocols, research contracts, study budgets and consent forms to extrapolate billing/coverage data
Strong organizational skills with ability to multi-task
Preferred: Ability to navigate CMS website
Preferred: Coding experience
Preferred: Scientific or healthcare background (i.e. Billing, clinical trials)
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
Must comply with personal protective equipment requirements as applicable

Benefits

Comp & perks

Annual influenza vaccination or approved exemption required
Equal opportunity employment
Drug-free workplace
Controlled-substance testing following employment offers