Washington University is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity or expression, national origin, genetic information, disability, or protected veteran status.
This position is full-time and works approximately 40 hours per week.
Department Name/Job Location:
This position is in the Center for Clinical Studies. The position is located at the Center for Outpatient Health. This position is for the Medical School Campus.
Position is responsible for performing Prospective Reimbursement Analysis to ensure that clinical services associated with clinical research studies are billed in compliance with the CMS National Coverage Decision and all other applicable laws and regulations, third party requirements, and Washington University School of Medicine (WUSM) policy. Participate in clinical research billing compliance related projects, analyze report data to identify problems associated with the patient billing and collection process, and propose solutions. Summarize and report on findings. The Clinical Research Billing Analyst will also provide assistance and function as a primary resource and educator to other staff in developing and/or negotiating clinical study budgets, informed consents and contracts within the Oncore Clinical Trial Management System.
PRIMARY DUTIES AND RESPONSIBILITIES:
Perform Prospective Reimbursement Analysis.
Perform detailed reviews of protocols, budgets, informed consent forms, contracts, FDA letters, and other relevant research documents to determine qualifying status and conduct a comprehensive MCA.
Create and revise MCA billing grids, derived from the protocol schedule of events, local and national treatment guidelines and relevant medical journal articles and citations.
Analyze Medicare benefit policies, coverage determinations, and medical practice guidelines related to study specific interventions.
Develop professional MCA reports according to institutional standards and procedures.
Collaborate with other pre-award staff, Investigator and the research study team to finalize the MCA report and billing grid.
Work with the CTMS Specialist to ensure data entry of billing indicators into OnCore.
Maintain an up-to-date understanding of Medicare’s Clinical Trial Policy (NCD 310.1) and newly issued guidance.
Maintain a close working relationship with clinical research billing compliance staff at affiliated hospital(s), university grant administrators, departmental clinical research staff, IRB members and staff, and compliance officers.
Continue to build a working relationship with BJH/C personnel and to develop mutually agreeable process to enhance clinical trial billing compliance and optimize account management for patients enrolled in clinical research studies. Assess nature and scope of clinical research study billing or reimbursement problems, investigate cause and report on findings. Provide recommendations on improvements to workflow, systems or any other process. Identify system functionality enhancements required to streamline data capture, billing and collections.
Provide guidance to PI’s, study coordinators, department administrators, and other parties on topics related to professional and/or technical billing in the context of clinical research.
Assist departments in determining the per subject portion of their budgets for sponsored research projects and industry clinical trials.
Coordinates with assigned clinical department’s/division’s compliance liaison(s) to facilitate compliance at the departmental/divisional level.
Respond to inquiries regarding coding, documentation, and billing compliance issues.
Maintain a current knowledge of laws and regulations governing professional fee billing and inform clinical departments, faculty, and staff of changes in federal regulations or University policy related to research and billing compliance.
Assist/perform special audits and/or other projects as assigned.
Bachelor’s degree or equivalent in medical billing, coding, nursing, or clinical trials.
Basic Microsoft Excel skills.
Intermediate Microsoft Word skills.
Minimum of two years’ work experience in a healthcare or clinical setting.�
Effective verbal, written and interpersonal communication skills.
Ability to organize/prioritize time and work independently.
Ability to apply generalized information to specific situations.
Knowledge of Medicare, Medicaid, and/or commercial payer guidelines, including NCD 310.1.
Knowledge of medical coding (i.e., HCPCS / CPT coding) and terminology.
Knowledge of regulations regarding the use of human subjects in clinical trials, outcomes research, nursing research, and other research areas.
Knowledge of drug/device development process and the pharmaceutical and/or medical device manufacturing industry.
The hiring range for this position is $56,472 - $72,009 annually.
All external candidates receiving an offer for employment will be required to submit to pre-employment screening for this position. Current employees applying for a new position within the university may be subject to this requirement. The screenings will include a criminal background check and, as applicable for the position, other background checks, drug screen, employment and education or licensure/certification verification, physical examination, certain vaccinations and/or governmental registry checks. All offers are contingent upon successful completion of required screening.
Please attach a copy of your most current signed performance evaluation (completed within the last 18 months) to your online account. If you have not received a performance evaluation, you may provide two current signed letters of recommendation (written within the last 18 months), preferably to include one letter from either a current or recent former supervisor. To attach these documents, go to: My Career Tools, Add Attachment, Attachment Type – Performance Reviews or Letters of Recommendation.
Applicant Special Instructions:
Normal office environment, local travel to the medical school/hospitals and physician’s offices.
Washington University in St. Louis, a medium-sized, independent university, is dedicated to challenging its faculty and students alike to seek new knowledge and greater understanding of an ever-changing, multicultural world. The University offers more than 90 programs and almost 1,500 courses leading to bachelor's, master's and doctoral degrees in a broad spectrum of traditional and interdisciplinary fields, with additional opportunities for minor concentrations and individualized programs. The faculty is composed of scholars, scientists, artists and members of the learned professions. They serve society by teaching; by adding to the store of human art, creativity, understanding, and wisdom; and by providing direct services, such as health care.