The Research Charge Analyst is a key member of the CHRISTUS Institute for Innovation & Advanced Clinical Care (CIIACC) whose primary role is to facilitate research billing compliance by ensuring that clinical charges associated with research subjects are accurate and billed to the appropriate payor and by creating coverage analyses in alignment with Medicare's Clinical Trial Policy and study protocols.
Review clinical charges for accuracy, using reports within the electronic medical record (Epic) and by reviewing actual charges against expected research services listed in study and billing documentation.
Verify that research clinical charge CPT codes match billing documentation and make revisions accordingly.
Review of physician and hospital-based charges incurred by patients enrolled in clinical trials, separating those considered routine care and billable to insurance/Medicare from those that are for research only and charged to the study sponsor or grant.
Pre-Enrollment: Coverage Analysis
Generate detailed and accurate Coverage Analyses (CAs) with budget overlay in a timely manner.
Review clinical trial protocols and related regulatory documents in order to prepare a billing plan for all medical procedures and services required in a clinical research project.
Review clinical research protocols and determine which procedures are routine, and therefore, billable to Medicare and other third-party payers based on CMS policy and National and Local Coverage Determinations as well as professional practice guidelines. Perform extensive independent research to identify applicable practice guidelines will be required.
Review patient informed consent forms to ensure that the document accurately informs patients which procedures will be billed to their insurance vs. those that will be covered by the study budget, in accordance with the CA.
Ensure consistency of the payment terms in the coverage analysis with the protocol, the informed consent form template, the budget and the contract payment terms.
Completely and effectively document CA determinations to support the decision-making process.
Screen research protocols to determine whether a formal Coverage Analysis is required.
Collaborate with investigators to determine whether each study is a qualifying clinical trial under CMS Clinical Trial policy.
Keep current with FDA, Medicare and other applicable regulations and state laws associated with clinical research billing.
Identify and understand federal regulations for medical/research budgeting purposes.
Communicate effectively and serve as a subject matter expert on Coverage Analyses.
Have a working knowledge of clinical trial management system(s) (CTMS). Perform clinical trial management system activities within the CTMS and conduct financial activities within the medical billing and coding software (EPIC).
Analyze and translate medical and clinical diagnoses, procedures, injuries, or illnesses into designated numerical codes within the coverage analysis/CTMS by assigning ICD-10-CM/CPT-4 diagnostic and procedure codes to patient billing intention with accuracy and attention to detail.
Code coverage analysis for use and planning by physicians, hospitals, research organizations, insurance companies and charge segregation.
Complete assignments according to established guidelines and schedules.
Conduct special department-related projects as they are assigned.
Perform other assignments as needed.
Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
Bachelor's degree in Healthcare Administration, Medical Coding, Auditing, Finance, Accounting, Nursing, or a related field required.
Four (4) years of clinical research experience required. Additional experience may be substituted for the educational requirement on a year-for-year basis for up to four (4) years.
General understanding of various payment and coding systems in healthcare.
Familiarity with different types of clinical research and the drug development process.
Understanding of FDA regulations related to clinical trials involving Investigational New Drugs (INDs) and/or Investigational Device Exemptions (IDEs).
Knowledge of Medicare coverage decisions, benefit policy manuals and billing processes.
Previous experience in research billing, budgeting/budgeting analysis for clinical trials, and/or Coverage Analysis creation.
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CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.