Anywhere The mission of The University of Texas MD Anderson Cancer Center is to eliminate cancer in Texas, the nation, and the world through outstanding programs that integrate patient care, research and prevention, and through education for undergraduate and graduate students, trainees, professionals, employees and the public.
The primary purpose of the Coverage Analyst is to prepare billing plans for clinical research studies that involve patient care costs. The Coverage Analysis Team is responsible for creating and revising billing plans for patient care costs for research studies involving clinical procedures. The Coverage Analyst maintains current knowledge and expertise in the research billing compliance, Medicare reimbursement policies, national and local coverage determinations for Medicare, and procedure coding. This team exercises a high degree of professional judgement, making informed, defensible and documented decisions. This position has a high degree of impact in reducing the potential for False Claims Act violations resulting from inappropriately billing Medicare for disallowed costs.
JOB SPECIFIC COMPETENCIES
Coverage Analysis (40%)
• Reviews research studies to determine whether the trials will include research-required clinical billing in Epic.
• Completes the QCT checklist and determines Medicare-qualifying status.
• Creates a billing plan. Billing plan will include scheduled and as-needed clinical procedures.
• Determines billing designations including a written rationale for all services determined to meet the routine cost definition per the Centers for Medicare and Medicaid (CMS) Clinical Trial Policy.
Coding & Costing (20%)
• Determines expected charges based on the study protocol and budget. Selects appropriate patient care charges and connects these charges with calendar events.
• Expected codes include professional and technical coding with expected costs that inform budget negotiation.
Study Modifications (20%)
• Processes modifications to the study calendar, billing plan, and expected charges subsequent to protocol amendment submission to the Scientific Review Committee (SRC) or Institutional Review Board (IRB).
• Coordinates the implementation of the modification with the activations, charge review, and study teams to ensure that participants are associated and visits are checked in on the appropriate version of the billing plan in both the clinical trials management system (OnCore) and the electronic medical record (Epic).
Collaboration and Cross-Training (20%)
• Works with the Principal Investigator (PI) and research team to understand, approve and implement the billing plan.
• Maintains a high level of professionalism and provides clear and consistent information about the billing compliance process.
• Works with other financial, budget and compliance teams as needed to minimize research billing compliance risk and increase awareness of downstream impacts of billing plan decisions.
Other duties as assigned.
Education
Required: Bachelor’s degree in healthcare or related field.
Experience
Required: None. May substitute required education with additional years of related experience on a one to one basis.
Preferred: Two years of clinical research experience
Certification Preferred : Coverage analysis or coding (CPC or CCS-P)
It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html
Additional Information
Requisition ID: 165242
Employment Status: Full-Time
Employee Status: Regular
Work Week: Days
Minimum Salary: US Dollar (USD) 66,000
Midpoint Salary: US Dollar (USD) 82,500
Maximum Salary : US Dollar (USD) 99,000
FLSA: non-exempt and eligible for overtime pay
Fund Type: Soft
Work Location: Remote
Pivotal Position: No
Referral Bonus Available?: No
Relocation Assistance Available?: No
Science Jobs: No
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