Clinical Research Coverage Analyst
We are seeking a Clinical Research Coverage Analyst who will be responsible for performing a comprehensive Prospective Reimbursement Analysis. The Clinical Research Coverage Analyst is responsible for reviewing clinical research protocols, Informed Consent Forms, Clinical Trial Agreements, and other relevant study-related documents to create a coverage analysis/billing guide. The coverage analysis adjudicates charges that are items or services considered to be routine cost and billable to patient’s insurance or research related, performed outside clinical care guidelines, and be billed to the study sponsor.
The Analyst is responsible for providing guidance and educating the study teams concerning appropriate clinical care vs research costs for participation in clinical trials and clinical research studies based on Medicare National Coverage Determinations (NCDs), specifically NCD 310.1 Routine Costs in Clinical Trials, Local Coverage Determinations (LCDs) and clinical care guidelines.
This position reports to the Sr. Director Research Administration
Specific Duties & Responsibilities
- Work closely with the School of Medicine Institutional Review Board to ensure research patient care costs are identified and informed consents are consistent with clinical research protocols and commercial contracts if applicable.
- Participate in the Research Patient Care Billing Training Program for clinical research personnel to include Pl, data-managers, research nurses, and research pharmacy.
- Educate and advise clinical research personnel on the planning and coordination of clinical research protocols.
- Participate in creating Standard Operating Procedures for Research Patient Care to include Prospective Reimbursement Analysis, research patient care costs, and research patient care billing.
- Effectively communicate results to departmental contact to ensure consensus regarding research patient care costs vs. routine of care.
- Participates in maintaining a comprehensive database of all Prospective Reimbursement Analysis grids, protocol and informed consent reviews and commercial contract budgets.
- Serve as liaison to external auditing activities by the federal government, the University's external auditor, or third-party insurers as related to research patient care billing.
- Conduct work in a medical management system, creating protocol calendars and coverage analyses.
Additional Knowledge, Skills & Abilities
- Ability to exercise independent judgement in the resolution of issues regarding clinical research billing compliance.
- Excellent written and oral communication skills.
- Strong understanding of clinical tests and medical terminology.
- Ability to work in a team, demonstrate good interpersonal skills, and work independently.
Minimum Qualifications
- Bachelor’s Degree in biological, physical or health sciences or related field.
- Five years in a clinical or clinical research environment.
- Knowledge of clinical research protocol management.
- Understanding of research patient care vs. routine care treatment.
- Familiarity with medical billing, reimbursement, and Medicare NCDs and LCDs.
- Additional experience may substitute for education requirement, and additional education may substitute for experience to the extent permitted by the JHU equivalency formula.
- Duties that differentiate Analyst from Specialist.
Classified Title: Clinical Research Coverage Analyst
Role/Level/Range: ATP/04/PD
Starting Salary Range: $62,900 - $110,100 Annually ($86,500 targeted; Commensurate with experience)
Employee group: Full Time
Schedule: M-F/8:30-5 pm
Exempt Status: Exempt
Location: Remote
Department name: SOM Admin Res Clinical Research Contract
Personnel area: School of Medicine