The Senior Clinical Research Charge Administrator will maintain in-depth understanding of the business drivers and organizational strategic directions pertaining to clinical research at City of Hope. S/he will be highly motivated, creative and offer innovative solutions to streamline processes involving financial management of clinical trials. S/he works closely with Clinical Trials Office, Research Services and Finance leadership to manage and report on clinical research professional and hospital billing, claim submission, processing and reconciliation for all clinical research activities across the City of Hope clinical enterprise.
The Senior Clinical Research Charge Administrator provides clinical research charge review, submission and reconciliation to ensure strict compliance with research billing regulations, policies, and procedures; functions as a resource for clinical department physicians and all appropriate research staff on clinical research billing and coding issues by disease and modality teams. S/he will be responsible for research and analysis of all complex, routine costs and non-routine cost charges. This analysis requires a comprehensive understanding of clinical research, research protocols, clinical research billing compliance, and associated documents as well as the ability to review and differentiate routine costs and non-routine costs research charges by leveraging coverage analyses and study documentation, including but not limited to physician, nursing and clinical staff medical notes. A thorough and current knowledge of all related compliance issues is also critical to this work. S/he will identify, research, and analyze information from all of these sources, make the appropriate determination as to whether a charge is research related and, if so, how it should be adjudicated and appropriately billed to study accounts or third party payers.
The Senior Clinical Research Charge Administrator will ensure research billing complies with applicable clinical research billing regulations and policies, protocol requirements, institutional billing compliance, coverage analysis documentation, clinical documentation, and appropriate charge adjudication, reimbursement and full cost recovery. Identifies workflow issues to allow resolution in a timely fashion to determine if charges represent clinical research services and distribute charges appropriately to financially responsible party with appropriate application of research billing modifiers, national clinical trials registration numbers (e.g. clinicaltrials.gov) and research specific code application. Develops and implements systems to support efficient billing and collection strategies to mitigate revenue leakage from clinical trial services and satisfy outstanding clinical research AR with efficiency and timeliness. Develops and implements effective service line and business metric reports that address respective stakeholder needs, including but not limited to physician investigators, study teams, revenue cycle, and City of Hope research leadership (including but not limited to: turnaround times, charge segregation, denials, and cost recovery).
- Responsible for adjudicating research-related charges appropriately by leveraging and reconciling research and clinical documentation, which may or may not be specifically defined in research protocols. Researches and analyzes those charges by reading physician medical notes and reviewing applicable research protocols, informed consent forms, coverage analyses, and other associated documents and resources. Makes informed determinations as to whether each charge is research related and, if so, how it should be billed. Appends applicable national clinical trials registration numbers and clinical research billing modifiers where appropriate.
- Oversees and resolves all clinical research charge activities. Provides comprehensive analyses and effective reporting of findings that encompass claim submission and status, payment history, rejection and denial analysis, and status of unpaid clinical research claims to investigators, business managers and other internal departments.
- Serve as an expert resource for clinical department physicians and all appropriate research staff on clinical research billing and procedural coding related issues by disease and modality teams.
- Assist with clinical trial financial accounting projects, including, but not limited to rapid improvement events. Assists with ongoing review of internal processes to streamline and/or create new more efficient processes in collaboration with research leadership; assist in executing process changes and assist with overseeing charge adjudication to completion and full cost recovery.
- Assist with policies and procedures, both design and implementation, as they relate to compliance with applicable clinical research billing laws, Medicare Coverage Analysis, National Coverage Determinations, Local Coverage Determination, and applicable statutes and regulations dealing with clinical trial billing.
- Identify and advise on operational improvements to enhance efficiency of clean-claim submissions for prompt payment and overall reimbursement of clinical research services. Collaborate with coverage analysts, budgeting and coding colleagues to provide a prompt and active feedback loop between front-end budgeting with back-end cost recovery.
- Interacts, establishes cooperative working relationships, and communicates effectively with co-workers and personnel in other departments, particularly Medical Center Clinical Departments, Clinical Trials Support Services, Clinical Trials Office, and Patient Financial Services to provide useful information, guidance and integrity to the clinical trial finance activities.
- Maintain professional growth and development. Keeps abreast of latest trends in the area of reimbursement, clinical research billing compliance, procedural coding, and other billing compliance related assignments.
Follows established City of Hope and department policies, procedures, objectives, performance improvement, attendance, safety, environmental, and infection control guidelines, including adherence to the workplace Code of Conduct and Compliance Plan. Practices a high level of integrity and honesty in maintaining confidentiality.
Performs other related duties as assigned or requested.
The following shared, organization-wide competencies describe the desired behaviors that will facilitate success at City of Hope:
- Communication - Expresses ideas clearly and constructively (written and spoken, upward and downward, one-on-one and with groups).
- Customer Service - Seeks to understand customer needs and works to exceed customer expectations (internal and external).
- Initiative - Looks for opportunities to improve performance; manages time, work, and relationships effectively and efficiently.
- Professionalism - Treats others with respect; abides by the institutional values; displays a positive and cooperative attitude; adheres to the workplace Code of Conduct and compliance policies.
- Stewardship - Identifies efficiencies to reduce redundancy and/or elimination of tasks resulting in savings of cost, resources, and or/time.
- Teamwork - Works proactively and collaboratively with others to streamline work and achieve mutual goals.
- 5+ years related experience working directly with clinical research charge review and billing or equivalent combination of education and experience.
- Working knowledge of clinical research invoicing and budgeting
- Medical terminology
- Proven working knowledge, experience with CPT, HCPCS, ICD10 and knowledge specific to clinical research billing..
- Analytical skills
- Excellent written and oral communication skills
- Attention to detail
- Manage multiple competing demands
- Proactively negotiate priorities
- Consistent and successful follow through on issues and problems
- Clinical research experience with proven understanding of study design and protocol development and analysis of fully executed clinical trial agreements.
- Thorough knowledge of Medicare Clinical Trials Policies, National Coverage Decisions, Local Coverage Decisions, and Limitations on Coverage, medical claims coding practices and clinical processes.
- Strong working knowledge and experience with clinical trial regulatory documents such as protocols and informed consents and Clinical Trial Agreements (CTA).
- Proven ability to facilitate and manage complex medical billing and reimbursement processes
- Extensive knowledge of Medicare and 3rd party carriers directly related to clinical research
- Excel, Word, Microsoft Office, iRIS, EPIC, OnCore
- Personal computer and peripheral equipment
Working / Environmental Conditions:
- Subject to many interruptions
- Occasionally subjected to irregular hours
- Exposed to material of a confidential nature
- Atmosphere and environment associated with an office setting
- Light physical effort (lift/carry up to 10lbs)
- Mostly sedentary work
- Occasional standing/walking
- Occasional reaching, stooping, bending, kneeling, crouching
- Occasionally lifts reports/binders