Job Description

Job Title: Manager, Clinical Trials Coverage Analyst
Department: Research Admin
Shift: 1st
Specialty: Clinical Trials
Job Number: 2023-1446
Date Posted: 05/02/2023
Position Type: Research

Job Qualifications:

Manager, Clinical Trials Coverage Analyst
The Clinical Trials Research Manager position for Rush University Medical Center will work directly with the Director of Clinical Trials Research Revenue Cycle. This position will ensure consistent financial & operational performance, and the attainment of specific and measurable departmental standards and goals, assist with the development of policies and procedures, continuously monitor key performance indicators, supervise routine and special projects analysis, and ensure the accuracy and completeness of the coverage analysis approval process and post-award management of the trial. This manager will be accountable for account information containing accurate and comprehensive data to provide timely reconciliation and invoicing for optimal reimbursement of services. The manager will be responsible for monitoring and improving research billing metrics and measures, in addition to working with and providing input to his/her supervisor to identify areas of opportunity within the manager's scope, escalate risk and resolve barriers. This position will provide direction, set priorities, and analyze workflow for research revenue cycle activities. The Manager will be responsible for managing, reconciling and invoicing all revenue secured by Clinical Trials Research Revenue Cycle, work closely with operations, sponsors, and accounting throughout each month to ensure invoices and credits are applied to each client account. The individual who holds this position exemplifies the Rush mission, vision and values and acts in accordance with Rush policies and procedures.
Principal Duties and Responsibilities:
1) Appropriately manage project billing by ensuring costs are correctly billed and invoices are uploaded to the CTMS in a timely manner; follow up with vendors, Project Managers and Accounting as necessary.
2) Work with Project Managers and sponsors to secure signed client contracts for MR projects in a timely manner.
3) Verify that EPIC payment files are accurate and subsequently uploaded for processing and fulfillment.
4) Revise previously invoiced projects for adjustments and reissue client invoices as needed
5) Work with IS on updates and other system changes regarding billing, profit calculation and other financials, etc.
6) Adjust project billing statuses as needed so that accounting has access to accurate client Statement Reports
7) Perform a reconciliation of revenues and costs with accounting and project managers
8) Work with Project Managers to secure third party vendors that are within project budgets.
9) Responsible for ensuring final invoices from the vendors are received and accurate based upon agreed costs.
10) Review accuracy and audits results.
11) Day to day supervision of the Budget/Invoicing (FA)analysts.
12) Consistently monitors employee performance.
13) Generates Epic and OnCore reports for analysis and communicates findings to Manager and team.
14) Ensures staff meets productivity standards.
15) Effectively communicates with Revenue Cycle colleagues, study teams, patients, Office of Research Affairs, IRB, RUMC Compliance, and all partners in the Research Continuum.
16) Provides resolution of escalated issues, including researching CA, Epic, OnCore, Rush Research Portal, and other sources necessary to provide support to staff.
17) Performs annual performance evaluations.
18) Participates in hiring, progressive discipline and termination processes.
19) Orients new staff and provides ongoing training to existing staff.
20) Ensures appropriate staffing levels.
21) Reviews quarterly staff-work files for quality.
22) Identifies staff issues and assists in resolution.
23) Stays current on all processes related to research billing.
24) Stays current on Medicare guidelines, policies and procedures governing Research billing.
25) Provides opportunities for regular training for staff. Coordinates training with Epic and OnCore team as needed.
26) Develops new ideas resulting in major improvements to existing methods, services, processes and/or procedures.
27) Identifies opportunities for the development and implementation of new solutions and/or exceeds staff/customer/patient needs.
28) Ensures protection of private health and personal information. Adheres to all federal and state compliance regulations.
29) Stays abreast of industry & regulatory changes impacting functional areas and revenue cycle. Identifies potential impact and required changes. Strives to promote best practices within functional area and revenue cycle; stays current on all processes and regulatory requirements specific to Research Billing.
30) Maintain a detailed understanding of Medicare's Clinical Trial Policy (NCD 310.1) and related guidance documents.
31) Performs related duties, as required.

Knowledge, Skills, and Abilities:
Knowledge:
Bachelor's degree in business, finance or related discipline; equivalent work experience may be considered in lieu of degree. At least five years of experience required in billing, collections, insurance, technology support, or customer service.
AAPC or AHIMA certification in coding with experience in research medical billing and coding. Certifications may include: Certified Professional Coder (CPC), Certified Coding Specialist (CCS) and Certified Medical Coder (CMC), and any other specialized coding certification approved by the two main governing bodies.
Understanding of Governmental and Commercial insurer payment practices and methodologies required.
Proficiency with medical terminology as well as medical research billing language. Must demonstrate a thorough knowledge of the three code sets that are currently in use: Current Procedural Terminology (CPT), ICD-10-CM, and Healthcare Common Procedure Coding System (HCPCS) Level II.
Have a working knowledge of clinical trial management system(s) (CTMS) as well as medical billing software (i.e. OnCore, EPIC).

Skills:

Excellent verbal and written communication skills due to direct interaction with senior management.
Strong time management and organizational skills with the ability to effectively multi-task and meet deadlines.
Strong problem solving and financial analytical skills. High degree of accuracy for analyses and processes.
Must have a strong customer service focus. Previous experience in Research Billing, Budgeting, Coverage Analysis, or other Research Finance background preferred.

Abilities:

Ability to plan, manage and implement projects.
Ability to interact professionally with all levels of employees; ability to manage diverse teams.
Aptitude for improving professional knowledge and technical skills through development efforts.
Ability to motivate, mentor and develop talent. Must have a high level of integrity.
Ability to observe charge entry trends, determine root cause of errors, identify possible solutions and implement changes to workflows as needed.
Ability to assert professional leadership in team meetings, providing staff with necessary documentation and pertinent summaries to improve productivity and reduce error rates.

Disclaimer:
The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements.

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