Job Summary
This position provides financial management oversight for all research and applicable sponsored activities conducted at or under the auspices of the organization. Primary responsibilities of this position include financial support for research operational leaders including assistance in the development of annual research operating budgets; project financial analysis (prospective and retrospective), development and negotiation of research/sponsored project budgets; project budget management including billing and reimbursement and education and training on research finance policies and processes. This position also provides expertise in research billing compliance issues and functions as a liaison to the patient financial services department, providing direction and guidance on research patient accounts.
Essential Functions
Manages key processes including clinical trials budget development, coverage analysis, financial negotiations, and research billing compliance and monitoring.
Analyzes financial terms, conditions and proposed budgets for all research sponsored projects and develops and negotiates those payment terms with sponsors to cover costs while adhering to fair market value; ensures final contracts reflect accurate budgets and are financially compliant.
Employs various electronic and manual systems within to ensure the accurate tracking of research visits and ensures payer coverage analysis determinations and contract terms are appropriately followed.
Develops and maintains an organized structure for identifying patients and research-related procedures in order to ensure appropriate patient billing procedures. Works collaboratively to resolve issues related to research billing and obtaining appropriate approvals and reimbursement from payers. When applicable, monitors research patient enrollment notifications to ensure Banner billing compliance by separating non-billable procedures from patient accounts.
Completes a Cost and Coverage Analysis on applicable projects utilizing feedback from research operational leaders, protocol requirements and knowledge of research and government regulations to evaluate each new study and determine appropriate coverage and billing requirements. Serves as a knowledgeable consultant to assist other personnel on the determinations of what patient care items and services are considered standard of care.
Serves as the research liaison for patient financial services (PFS) to assure accurate billing of diagnostic and procedural information on research patient accounts ensuring all charges billed to third party payers are appropriate and not reimbursed by the sponsor. Monitors research accounts on hold until coding is performed accurately and notifies PFS when accounts are ready for billing.
Contributes to the development of education and training programs for operational leaders and staff as applicable to ensure consistency and overall compliance with research cost determinations and billing regulations; keeps abreast of current regulations, i.e., Medicare, Medicaid and other industry research regulations. Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Promotes collegiality between physician investigators, staff, facility administrators, and department heads by providing all customers of with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.
Minimum Qualifications
Bachelor Degree in Accounting, Business or Finance or an equivalent combination of education and experience.
Minimum of 4 years of experience in Health Care billing, reimbursement, and coding, or a minimum of 6 years overall financial experience. Requires excellent organization, oral and written communication skills. Must maintain highly confidential data. Knowledge of Contract & Government Payer compliance and reporting requirements required.
PC and various other system application proficiencies required, including advanced MS Excel skills.
Preferred Qualifications
Additional related education and/or experience preferred. Knowledge of CPT-4/HCPCS, ICD-10 codes and UB04 and CMS 1500 claim forms are preferred. Prior experience in Research or similar setting managing federal grants/clinical trials and knowledge of clinical trials management systems.
Additional related education and/or experience preferred.
