Research Billing Compliance and Budget Analyst (40 hours/week)

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Summary

1.0 FTE, Day shift. Remote/hybrid opportunity. Ideally, in-person for onboarding then shift to hybrid format.

Job Description

POSITION SUMMARY: Administrates LG Health’s use of clinical research management software (CRMS). Manages both pre- and post-award research administration activities for clinical studies throughout the Lancaster General Health (i.e., Research Institute, Ann B. Barshinger Cancer Institute, and any other department). Pre-award, performs contracting, budgetary, or financial compliance activities, or oversees work of contractor that may perform these activities. Post-award, builds study calendars and budgets in the CRMS and uses the CRMS for research reporting, invoicing, and financial reconciliation. The primary purpose of both the pre- and post-award responsibilities is to ensure timely and quality research conduct while decreasing legal and financial risk for investigators and the institution. Works collaboratively with all process owners to ensure adherence to and documentation of all processes.

ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:

• Independently work with institutional departments to perform a clinical research budget analysis to determine cost feasibility and progress to budget negotiation with the Sponsor. During the performance of the budget analysis, generate a coverage analysis and billing grid, in accordance with all applicable Medicare clinical trial policies and rules, to promote appropriate research associated billing and to identify parties responsible for payment of research related activities. 
• Perform a review, provide comments to regulatory staff regarding draft informed Consent Form (ICF), pertaining to cost language.
• Review contract and/or protocol amendments and evaluate impact on budget, Medicare Coverage Analysis and Billing Plan; work with research staff to ensure adequacy of Sponsor funding.
• Ensure the billing grid is used appropriately, resulting in accurate invoicing.
• Identify, analyze and resolve issues related to research billing and resolve claims requiring edits, claims submitted in error or returned claims.
• Review research patient accounts for research billing compliance with government and private payer legal requirements and Sponsor documents. Work with appropriate departments to expedite reconciliation of any account issues.
• Work with appropriate departments to reconcile research patient accounts with the established research budgets.
• Generate reports for management and queries for research coordinators. Analyzing research income, expenses, and personnel effort reporting by study and service line to identify need for adjustment of budget or personnel effort.
• Distribute research billing requirements, new regulations or regulatory changes regarding research billing elements to the appropriate personnel.
• Support institutional development and implementation of research billing related policies, procedures and standard operating procedures (SOP), and subsequent standards training.
• Maintain current knowledge of applicable research related Medicare and Medicaid reimbursement guidelines and requirements and apprise institutional management as indicated.
• Maintain current knowledge of research billing guidance and regulator changes, the current claims and billing codes requirements and of the CMS uniform bills and forms requirements especially as they relate to Medicare Clinical Trial Policy and train research billing department personnel as indicated.
• Serve as an expert resource to management with regards to research due diligence as it relates to Medicare and Medicaid policies and coverage.
• Review clinical trial documents for the nature of the study and every protocol item/service to be provided to determine if the study is a qualified clinical trial pursuant to the CMS National Coverage Determination 310.1 (the Medicare Clinical Trial Policy) or otherwise approved by CMS.
• Create full budget and coverage analysis for every study regardless of funding source (e.g., industry, government or other identified funding source), or the absence.
• Conduct Medicare Coverage Analysis on all clinical research projects to determine appropriate payer source for clinical trial services applying coverage rules to develop budget justification in the trial budget.
• Generate a Coverage Analysis document and Billing Plan according to Medicare rules to ensure all charges associated with the research activities are billed to the appropriate parties. Communicate the results of the coverage and budget analysis with the Principal Investigator. The coverage analysis is used to build an internal cost-based budget for all items/services that cannot be billed to insurance and therefore need to be paid by a sponsor or other funding source.
• Review budget and conduct budget development for clinical research projects to ensure costs associated with research activities are fully recovered.
• Corrects charges billed in error to research that should be paid by insurance, by performing a research correction/transfer in Epic.
• Corrects charges billed in error to insurance that should be research, by performing a research correction/transfer in Epic.
• Coordinate with study teams and appropriate ancillary/support units on pricing when creating budgets.
• Communicate identified study funding gaps to appropriate leadership in a timely manner.
• Thoroughly evaluate research activities and legal requirements to ensure government and/or private payers are not invoiced inappropriately.
• Identify, analyze and resolve issues related to research patient accounts for proper payment from Sponsors, patients and/or third parties.
• Provide subject-matter expertise on complex research billing and compliance issues.
• Maintain knowledge of and compliance with institutional research policies, procedures and guidelines, as well as governmental regulations regarding responsible conduct of research, research ethics and integrity, and protection of the safety and welfare of human subjects (including DHHS, FDA, IRB, and HIPAA research regulations as applicable).
• Establish and maintain an exceptional professional working relationships with Research Coordinators, Principal Investigators, Patient Financial Services, Compliance, Accounting, non-LGH providers, sponsors and funders, and any other parties involved with financial and billing processes for research to ensure accurate documentation, coding, charging, and billing for all services provided related to research.
• Provide project management during study start-up, which includes study start-up meetings and documentation of study start-up processes and progress.

SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:

• Instructs less experienced personnel and advises others to ensure that research is conducted safely and in compliance with the above.  Reports apparent or potential problems to Human Research Protections Program Institutional Official.
• Manage onboarding and training activities for new research staff.
• Maintains established policies and procedures, objectives, quality assessment, safety, environmental and infection control standards.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
• Other duties as assigned.

JOB REQUIREMENTS

MINIMUM REQUIRED QUALIFICATIONS:

• Bachelor’s degree in health, life science, finance, business or related course of study.
• 3 years of recent experience in healthcare finance
• Clinical background or understanding of medical terminology to support protocol review.
• Familiarity with insurance billing and knowledge of medical claims coding practices and clinical processes and coding certification (i.e., CPC, RHIT).
• Understanding or ability to rapidly develop an understanding of Medical Clinical Trial Policy.

PREFERRED QUALIFICATIONS:

• Master’s in Health Information Management, Nursing or other healthcare related field.
• 3 years of recent experience in clinical research compliance and billing, finance, accounting, coding.

ESSENTIAL JOB-RELATED EXPERIENCE:

• Basic working knowledge of medical terminology, ICD-9, ICD-10, CPT, HCPCS, DRG, APC, FDA, billing practices; Human Subject Research Protection, revenue and charge master codes, Continuous Process Improvement.
• Experience in tracking and managing research finances.
• Basic understanding in the responsible conduct of research, including medical/research ethics, protection of the safety and welfare of human subjects in research, and good clinical practices.
• Excellent organization skills; ability to follow multiple, detailed directions of various research protocols; excellent oral and written communication skills; excellent computer skills including word processing, spreadsheet, relational database, project management, statistical and graphics software; ability to work independently; general knowledge of clinical research principles, regulations and guidelines; proficient in Microsoft Office.

Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job.  It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards.  The percentages of time spent performing job duties are estimates, and should not be considered absolute.  The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole.  Incumbent must be able to perform all job functions safely. #LI-LS1

Disclaimer

LGH Full Time Posted on 04/20/2023