"Clinical Trials Billing Specialist"

JOB SUMMARY:

Under general direction, assists the Clinical Trials Billing Manager with analysis and understanding of the critical study documents. Assists with research billing compliance reviews and audits; is responsible for review of medical records and medical research record documentation to ensure timely and accurate billing of all medical and research study services across various systems. Has general knowledge of CMS and Third-Party Payer billing rules; interfaces with various departments, physicians, clinical research nurses, coordinators, sponsors and local hospital affiliates when appropriate.

JOB DUTIES:

• In relation to industry sponsored research, assists with the review of medical records to evaluate accuracy of codes for medical billing and to ensure that all services have been captured. Applies general knowledge of CMS regulations and third-party payer guidelines to confirm correct coding practices to medical claims. Responds to clinical trials billing inquiries and ensures timely processing of billing errors and corrections. Responsible for receiving/processing monthly professional and facility charge invoices and distributes them to respective SOM departments. Responsible for the follow-up on unpaid invoices.
• Manages the encounter linking workflow process and ensures patients are accurately associated to the correct research study in the medical record system. Responsible for study close-out removal of research associations.
• Assists with financial audits and study close-out reconciliation.
• Assists with ensuring the Clinical Trials Management System includes accurate data which correlates with the information presented in other documents and systems.
• Attends meetings, performs other duties as assigned.

KNOWLEDGE, SKILLS & ABILITIES:

• Working knowledge of Medicare/Medical billing/coding processes
• Working knowledge of Medical and Research billing and coding utilizing CPT, ICD-10 and HCPCS
• Knowledge of EPIC
• Intermediate Excel skills
• Ability to efficiently operate computer software for Electronic Health Record and Practice Management Systems
• Ability to evaluate system edits for appropriateness of coding
• Strong interpersonal and customer service skills
• Excellent time management, organizational and multitasking skills
• Ability to maintain confidentiality

MINIMUM QUALIFICATIONS:

Associates degree supplemented with two (2) years of related work experience OR a High School Diploma supplemented with four (4) years medical billing, clinical trial billing or health insurance experience. Certified Coding Specialist certification preferred.