The Senior Research Billing Compliance Specialist serves as an advanced subject matter expert and senior individual contributor responsible for the accurate review, adjudication, and oversight of clinical research charges. Reporting to the Research Billing Compliance Lead, this role completes complex research billing compliance activities, including charge review, correction, and reconciliation, ensuring alignment with Coverage Analysis determinations, study billing grids, institutional policies, and applicable federal research billing regulations.

This position requires deep expertise in revenue cycle operations, clinical trial billing regulations, and system applications, including MiChart and OnCore. The Senior Specialist partners closely with research teams, billing stakeholders, and compliance leadership to ensure appropriate charge routing, defensible documentation, and compliant billing practices. This role serves as a key resource for issue resolution, driving timely and accurate outcomes for complex, high-risk, or non-standard billing scenarios while identifying trends and recommending process improvements.

The Senior Specialist is responsible for completing complex charge review for patients enrolled in clinical research studies in accordance with Medicare (CMS), other third-party payer requirements, and Clinical Trial Agreements (CTAs). This includes ownership of work queues, advanced charge and claim edit resolution, and denial management to ensure accurate and timely billing to study accounts, third-party payers, and patients. Additionally, the Senior Specialist provides guidance and mentorship to intermediate staff, supports training initiatives, and helps ensure ongoing compliance through quality assurance and continuous process improvement efforts.

• Analyze and perform complex review of daily hospital and/or professional charges for complex 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.
• Lead the resolution of complex research billing discrepancies, including processing charge corrections and ensuring timely and accurate outcomes.
• Serve as a subject matter expert in partnering with revenue cycle teams to investigate, resolve, and prevent research-related denials, including identification of root causes and implementation of corrective actions.
• Ensure research charges are accurately routed with appropriate modifiers, diagnoses, and supporting documentation to meet compliant billing standards and regulatory requirements.
• Act as a primary resource for research billing inquiries, providing guidance and education to study teams, billing staff, and other stakeholders on clinical trial billing compliance.
• Independently manage and resolve complex or high-risk billing issues, escalating only the most ambiguous or systemic concerns to Lead or leadership as appropriate.
• Identify, analyze, and reconcile variances between hospital and professional billing entries against required charge routing based on the CA, including trend identification and recommendation of process improvements.
• Ensure adherence to all Michigan Medicine clinical research billing policies and procedures while promoting a culture of compliance, accountability, and operational excellence.
• Maintain advanced knowledge of Medicare Clinical Trial Policy (NCD 310.1), FDA regulations, and applicable federal and state requirements; proactively monitor regulatory updates and assess operational impact.
• Provide mentorship and guidance to intermediate staff, supporting onboarding, training, and ongoing competency development.

• Bachelors Degree in Business, Finance, Health Information Management, or a related field; or equivalent experience/certifications.
• Minimum of five 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
• Advancedknowledge 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.

• 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.

The Senior Research Billing Compliance Specialist serves as an advanced subject matter expert and senior individual contributor responsible for the accurate review, adjudication, and oversight of clinical research charges. Reporting to the Research Billing Compliance Lead, this role completes complex research billing compliance activities, including charge review, correction, and reconciliation, ensuring alignment with Coverage Analysis determinations, study billing grids, institutional policies, and applicable federal research billing regulations.

This position requires deep expertise in revenue cycle operations, clinical trial billing regulations, and system applications, including MiChart and OnCore. The Senior Specialist partners closely with research teams, billing stakeholders, and compliance leadership to ensure appropriate charge routing, defensible documentation, and compliant billing practices. This role serves as a key resource for issue resolution, driving timely and accurate outcomes for complex, high-risk, or non-standard billing scenarios while identifying trends and recommending process improvements.

The Senior Specialist is responsible for completing complex charge review for patients enrolled in clinical research studies in accordance with Medicare (CMS), other third-party payer requirements, and Clinical Trial Agreements (CTAs). This includes ownership of work queues, advanced charge and claim edit resolution, and denial management to ensure accurate and timely billing to study accounts, third-party payers, and patients. Additionally, the Senior Specialist provides guidance and mentorship to intermediate staff, supports training initiatives, and helps ensure ongoing compliance through quality assurance and continuous process improvement efforts.

• Analyze and perform complex review of daily hospital and/or professional charges for complex 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.
• Lead the resolution of complex research billing discrepancies, including processing charge corrections and ensuring timely and accurate outcomes.
• Serve as a subject matter expert in partnering with revenue cycle teams to investigate, resolve, and prevent research-related denials, including identification of root causes and implementation of corrective actions.
• Ensure research charges are accurately routed with appropriate modifiers, diagnoses, and supporting documentation to meet compliant billing standards and regulatory requirements.
• Act as a primary resource for research billing inquiries, providing guidance and education to study teams, billing staff, and other stakeholders on clinical trial billing compliance.
• Independently manage and resolve complex or high-risk billing issues, escalating only the most ambiguous or systemic concerns to Lead or leadership as appropriate.
• Identify, analyze, and reconcile variances between hospital and professional billing entries against required charge routing based on the CA, including trend identification and recommendation of process improvements.
• Ensure adherence to all Michigan Medicine clinical research billing policies and procedures while promoting a culture of compliance, accountability, and operational excellence.
• Maintain advanced knowledge of Medicare Clinical Trial Policy (NCD 310.1), FDA regulations, and applicable federal and state requirements; proactively monitor regulatory updates and assess operational impact.
• Provide mentorship and guidance to intermediate staff, supporting onboarding, training, and ongoing competency development.

• Bachelors Degree in Business, Finance, Health Information Management, or a related field; or equivalent experience/certifications.
• Minimum of five 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
• Advancedknowledge 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.

• 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.