We are seeking a Manager Coverage Analysis PSJH who will be responsible for the execution of clinical trial coverage analysis standards in accordance with CMS determinations, federal regulations, and state and federal laws and regulations. Along with the Director of Research Billing Compliance, this position will establish a standardized process for coverage analysis development for all clinical trials throughout PSJH and use the CTMS to document determinations. This position will support the invoicing process and collection of non-standard charges, and provide subject matter expertise in the appeals of improperly denied charges by commercial or governmental payors. This position is responsible for monitoring federal and state laws and regulations regarding coverage of clinical trials, and disseminating best practice information to the team of analysts.
In this position you will have the following responsibilities:
- Responsible for providing leadership and expertise for accurate, efficient, and consistent coverage analysis development for PSJH studies.
- Establish standards and practices that minimize risk and errors and maximize revenue collection.
- Establish consistent and efficient process for coverage analysis and ensure all regions are aligned. Support processes with rigorous audit plan.
- Establish consistent and efficient process for clinical trial ad-hoc invoicing and ensure all regions are aligned. Support processes with rigorous audit plan.
- Cultivate and maintain positive working relationships with internal stakeholders as well as external sponsoring agencies.
- Responsible for achieving established metrics and other monitoring mechanisms to assure that coverage analysis work flows and processes are meeting the needs of the research teams in a timely and efficient manner.
- Manage team with high level of expertise in complex federal and state laws and regulations, CMS determinations and guidance, and other matters pertaining to clinical trial coverage analysis development.
- Collaborate with CTMS team, Research Budgeting team, Research Contracting Team, as well as Finance and HRPP, for process alignment, adherence to standards, and accuracy of key study documents.
- Provides oversight and direction to employees supervised and assures effective channels of communication are established. Provides professional development for team.
- Supports Director of Research Operations with the direction and execution of the enterprise research strategic plan.
- Reports areas of concern to the Office of Integrity and Compliance and works closely with them to resolve the issue.
- Participates as an active member of the research operations team.
Required qualifications for this position include:
- Bachelor's Degree or equivalent education/experience.
- 6 years relevant experience with clinical research billing in a highly matrixed organization.
- 6 years proven experience working collaboratively with researchers, physicians, federal authorities/agencies.
- 6 years expert knowledge in federal and regulatory requirements around research billing.
- 4 years experience managing and developing teams.
Preferred qualifications for this position include:
- 1 year ability to manage team members remotely.
About the department you will serve.
Providence Shared Services provides a variety of functional and system support services for our Providence family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.