Primary City/State:

Phoenix, Arizona

Department Name:

Research Admin-Rsrch

Work Shift:

Day

Job Category:

Finance

POSITION SUMMARY
This position provides pre-initiation research study evaluation including cost, coverage, and overall financial benefit analysis. Ensures analytical evaluations provide relevant and complete measures of cost, revenue, and billing projections and processing. Ensures regulatory compliance and financial coverage. Develops and maintains effective project relationships. Translates medical service priorities into effective research development activities and support allocations to ensure research leads to desired outcomes consistent with organizational goals.

CORE FUNCTIONS
1. Completes Cost and Coverage Analysis. Completes CCA for all BH research studies utilizing clinical skills, good clinical practices and knowledge of research and government regulations to evaluate each new study and determine appropriate coverage and billing requirements. Serves as a knowledgeable consultant to guide other personnel on the determinations of what patient care items and services are considered standard of care. Creates study budget for any and all research activity occurring within a BH facility to accurately determine relevant costs associated with all research activity. Negotiates study budget, with study Sponsor integrating Medicare Coverage rules and allowances into contract to ensure proper reimbursement and study billing requirements are met. Assesses study financial risk/benefit ratio.

2. Ensures regulatory compliance and financial coverage. Ensures compliance with required federal, state, funding source, and other applicable governing entities regarding regulations, laws, and statutes governing the scope of research activity. Accesses the Clinical Trials Management System to obtain names of human subjects to ensure that research related charges are billed appropriately. Acts as a liaison between finance departments, patient financial services, facility research directors and system reimbursement services for the purpose of communicating information regarding the National Coverage Decision for clinical trials and other federal research regulations. Serves as a resource and provides leadership assistance for research participants; asks questions regarding financial coverage issues to ensure service excellence.

3. Performs for cause and random patient account audits to ensure compliance.

4. Develops and maintains effective project relationships. Coordinates closely with Banner Research and University of Arizona staff in the study approval process; meets project timelines and department goals of optimal clinical, operational, financial and satisfaction outcomes. Interacts with sponsors, physicians, colleagues, facility administrators, facility CFOs and patient financial services to ensure effective communication and project coordination. Translates medical service priorities into effective research development activities and support allocations to ensure research leads to desired outcomes consistent with organizational goals. Leads and administers research projects by promoting research and collegiality between physician investigators, staff, facility administrators, and department heads. Leads, facilitates and or participates in task forces or councils to plan, implement and coordinate programs and/or activities for the organization.

5. This position is responsible for evaluating approximately 100 new study proposals per year with a research budget in excess of $3 million. Negotiates study budget, integrating Medicare Coverage rules and allowances into contract to ensure proper reimbursement and study billing requirements are met. Translates medical service priorities into effective research development activities and support allocations to ensure research leads to desired outcomes consistent with organizational goals.

MINIMUM QUALIFICATIONS

Bachelor’s degree in business or healthcare related field or an equivalent combination of education and experience.

Three to five years related experience working directly with clinical research charge review and billing, coverage analysis, and clinical trials budgeting and negotiations. Proven analytical and modeling skills. Working knowledge of computer spreadsheets and other computer applications.

PREFERRED QUALIFICATIONS

Proven working knowledge of medical terminology and experience with CPT, HCPCS, ICD10 codes as they relate to clinical research billing. Experience utilizing a Clinical Trials Management System.

Additional related education and/or experience preferred.