Intermediate Research Billing Compliance Specialist

The Intermediate Research Billing Compliance Specialist serves as a key operational contributor responsible for the accurate review, adjudication, and processing of clinical research charges. Reporting to the Research Billing Compliance Lead, this role supports daily research billing compliance activities through the execution of charge review, and reconciliation in alignment with Coverage Analysis determinations, study billing grids, institutional policies, and applicable federal research billing regulations.

This position requires a working knowledge of revenue cycle processes, clinical trial billing requirements, and system applications, including MiChart and OnCore. The Intermediate Specialist collaborates closely with research teams, billing partners, and compliance staff to ensure accurate charge routing, appropriate documentation to support compliant billing, and timely resolution of issues. The role emphasizes transactional accuracy, quality assurance, and efficient resolution of routine research billing discrepancies, with escalation of complex or non-standard items as needed.

The Intermediate Specialist is responsible for reviewing charges for patients enrolled in clinical research studies in accordance with Medicare (CMS) and other third-party payer guidelines, as well as Clinical Trial Agreements (CTAs). This includes managing work queues, resolving charge and claim edits, and addressing denials to ensure accurate and timely billing to study accounts, third-party payers, and patients.

Charge Review & Billing Accuracy

• Analyze and perform complex daily review of hospital and/or professional charges for clinical trials generated across all hospital ordering systems to make determinations on charge segregation of items and services using the coverage analysis (CA) billing grid and other medical documentation.
• Ensure research charges are routed accurately with appropriate modifiers, diagnoses, and documentation to support compliant billing.

Denials Management & Issue Resolution

• Partner with revenue cycle billing to resolve research-related denials.
• Escalate complex or non-standard billing issues to Senior/Lead staff as appropriate.

Compliance & Regulatory Adherence

• Responsible for identifying variances between the hospital and professional billing entries against required charge routing based on the Coverage Analysis.
• Ensure compliance with all Michigan Medicine clinical research billing policies and procedures. Know, understand, incorporate, and demonstrate the core mission and values of Michigan Medicine in all practices.
• Maintain an up-to-date understanding of Medicare's Clinical Trial Policy (NCD 310.1) and newly issued guidance, FDA regulations, and applicable federal and state statutes.

Stakeholder Support & Communication

• Respond to research billing inquiries from study teams and other research staff.
• Collaborate with internal stakeholders to support accurate and compliant research billing practices

Required Qualifications

• Associates Degree in Business, Finance, Health Information Management, or a related field; or equivalent experience/certifications.
• Minimum of three years of experience in a healthcare revenue cycle or clinical operations role, with experience in healthcare compliance, general healthcare billing, research billing, or research billing compliance
• Knowledge of CMS billing rules and regulations such as National Coverage Determinations, Local Coverage Determinations, and specifically the Clinical Trial Policy (NCD 310.1).
• Familiarity with CPT/HCPCS coding and hospital billing (UB-04/1500).
• Experience with electronic health record systems.

Preferred Qualifications

• Bachelors Degree in Business, Finance or Healthcare field with a minimum of five years' experience in professional and hospital billing, facility coding process and/or reimbursement experience, including familiarity with the functions and compliance concerns related to revenue cycle activities.
• ACRP/SoCRA (or equivalent) certification preferred.
• Familiarity with government websites, and/or non-government websites and any other information systems needed during detailed review is expected.
• Knowledge of University of Michigan and UMHS policies, procedures as well as regulatory requirements.
• Proficient with MiChart, knowledge of IRB process, E-Research, Clinical Trial Protocols, OnCore and compliance.
• Strong analytical, organizational, and problem-solving skills.
• Demonstrated ability to meet or exceed institutional goals and priorities in a fast-paced, high volume workload environment.