Clinical Research Specialist

Northwell Health

About The Position

Supports clinical research billing compliance and all aspects of clinical trials billing reviews. Provides daily coordination, monitoring and management of accounts for clinical trials. Directs and monitors all research account activity, provides administrative support and assists with establishing research study records in the electronic health record. Ensures all facility charges and professional fees from clinical research protocol visits are consistently segregated and billed to the appropriate payor and/or sponsor and properly reimbursed to avoid denials and mitigating billing risks.

Requirements

Bachelor's Degree required, or equivalent combination of education and related experience.
1-3 years of relevant experience, required.

Nice To Haves

EPIC research billing experience, strongly preferred

Responsibilities

Follows all clinical trial subject accounts to assure timely review, processing, payment, and accurate reimbursement.
Performs detailed analysis of clinical trial accounts and agreements using multiple resources and systems including EPIC for decision making of whether charges are billable to insurance or billable to the study.
Responsible for the contacting third-party payers to verify timely billing requirements. Add and update clinical trial information on patient accounts.
Effectively utilizes reports, and special projects to resolve claim rejections on accounts as well as identify problem accounts. Identifies and takes action needed to resolve accounts. Resolves problem accounts using all available resources, both internally and externally, as evidenced by observation, documentation, and feedback. Respects confidentiality of patient information and uses discretion when answering questions.
Assists in performing routine billing functions/job duties accurately and efficiently. Assists in processing all inpatient, outpatient and reoccurring accounts for all payers and all facilities, in an accurate, compliant, and timely manner by investigating billing errors.
Performs remediation of charge errors discovered during review EPIC review.
Determines and adds appropriate billing modifiers and other CMS (Centers for Medicare & Medicaid Services) requirements for billing research-related charges to subjects insurance.
Knowledgeable about CMS and Fiscal Intermediary medical necessity guidelines and their impact on billing and reimbursement in clinical research.
Audit and review accounts to ensure accuracy; investigate and correct errors, follow-up on missing account information, and resolve past due accounts.
Works with clinical research, coding, billing, compliance, and other internal or potentially external professionals to reconcile any discrepancies in data entered in the system.
Prepares statements and invoices based on services rendered every month; maintains accounts receivable by processing sponsor payments, site payments and accounts payable reports; invoice matching, data entry and reconciliation of accounts.
Posts payments and check deposits.
The Clinical Research Representative ensures that all charges for facility and professional fees arising from clinical research protocol visits and services are consistently segregated and billed to the appropriate payer and/or sponsor, submitted with proper codes, IDE# if applicable, modifiers and NCT number, and properly reimbursed, avoiding efforts in managing denials and mitigating risks of double-billing to both a study sponsor and an insurer.
Reviews research informed consent to understand the charges to patients, the Medicare coverage analysis, the billing grid, and the National Coverage Decision (NCD) for clinical trials.
Performs related duties as required.