Research Charge Analyst
Reporting to the Associate Director of the Yale Center for Clinical Investigations, this position will ensure the timely and efficient flow of clinical trial billing and reimbursement operations in a determined segment of School of Medicine departments. Updates appropriate procedures when discrepancies are found while working in collaboration with departmental study staff, Yale Center for Clinical Investigation, YNHH including HSR, Bridgeport and Greenwich, NEMG and Yale Medical. The position will be responsible for research and analysis of all complex, non-routine charges. This analysis requires a comprehensive understanding of research, research protocols and associated documents as well as the ability to review and identify non-standard research charges in physician medical notes. A thorough and current knowledge of all related compliance issues is also critical to this work.
This position will identify, research and analyze information from all of these sources, make the determination as to whether a charge is research related and, if so, how it should be billed. In addition, compliance is a major responsibility for the central team especially with the system updates to Epic and OnCore. With the Yale commitment to be early adopters for any/all new versions, new applications and upgrades to Epic and OnCore, this central team will serve as the primary source for process improvement and enhancement recommendations with both vendors as well as across the Yale enterprise. This position will ensure compliance with protocol requirements, institutional billing compliance and appropriateness of charges and reimbursement. Identifies workflow issues to allow resolution in a timely fashion to determine if charges represent clinical research services and distribute charges appropriately to financial responsible party with solid application of research specific modifiers and research specific code application. Develops and implements systems to support efficient billing and collection strategies to maximize income from clinical trial services and satisfy outstanding clinical research AR with efficiency and timeliness.
- Responsible for identifying potential clinical research charges not specifically defined in research protocols. Researches and analyzes those charges by reading physician medical notes and reviewing research protocols, informed consent forms, and other associated documents. Makes determination as to whether each charge is research related and, if so, how it should be billed.
- Oversees and resolves all clinical research charge activities for all clinical departments and/or sections. Provides continuous comprehensive, detailed analyses of findings that encompass claim submission and status, payment history, rejection analysis, frequency and status of unpaid clinical research claims via strict communication and on-going updates to department administration, physicians and coders.
- Identify and advise on operational improvements to enhance efficiency of clean-claim submissions for prompt payment and overall reimbursement of clinical research services which will result in developing, implementing, and monitoring comprehensive policies and procedures for University-wide clinical research claims, invoicing and reimbursement. Functions as a resource and educator for clinical department physicians and all appropriate professional and research staff on clinical research billing, reimbursement and coding issues by department and disease.
- Assists with the development of OnCore and Epic training and educational programs for clinical research billing while demonstrating project management skills to independently carry out projects as assigned or appropriate. Impeccable attention to detail with high level of accuracy.
- Researches policies of payers and communicates changes as appropriate. Maintains regular interactions and communication with third party payers while ensuring compliance with University, governmental and all third party regulations, including claim submission, coding accuracy and documentation to support billing. Performs quality assurance processing and assesses degree of risk for non-compliance with internal audit findings.
Required Education and Experience
Bachelor’s degree in a related field and one year of related work experience in the same job family or an equivalent combination of experience and education. Must be knowledgeable in regional and federal regulations with the ability to perform independent decision-making on a daily basis.
Required Skill/Ability 1:
Clinical research experience with proven understanding of study design and protocol development and analysis of fully executed clinical trial agreements. Proven ability to facilitate and manage complex medical billing and reimbursement processes.
Required Skill/Ability 2:
Demonstrated project management skills to independently carry out projects as assigned or appropriate. Impeccable attention to detail with a high level of accuracy. Demonstrated proficiency with Microsoft applications: Excel, PowerPoint, Access, Word and experience with database management.
Required Skill/Ability 3:
Excellent organizational and analytical skills. Ability to function well with conflicting demands and deadlines. Well-developed planning, problem resolution and decision-making skills.
Required Skill/Ability 4:
Proven ability to work successfully within a team environment and as an individual contributor. Outstanding interpersonal and teamwork skills and demonstrated professionalism in both verbal and written communication.
Required Skill/Ability 5:
Extensive knowledge of Medicare and 3rd party carriers directly related to clinical research. Thorough knowledge of medical terminology, medical chart audits for research activity.
Preferred Education, Experience and Skills:
Working experience with CPT, HCPCS, ICD9, ICD10 certified and knowledge specific to research.
Preferred Licenses or Certifications:
CPC and/or CPC-H with proven working knowledge.
Weekend Hours Required?
Evening Hours Required?
Background Check Requirements
All candidates for employment will be subject to pre-employment background screening for this position, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position description and job requirements. All offers are contingent upon the successful completion of the background check. Please visit www.yale.edu/hronline/careers/screening/faqs.html for additional information on the background check requirements and process.
The intent of this job description is to provide a representative summary of the essential functions that will be required of the position and should not be construed as a declaration of specific duties and responsibilities of the particular position. Employees will be assigned specific job-related duties through their hiring departments.
Affirmative Action Statement:
Yale University considers applicants for employment without regard to, and does not discriminate on the basis of, an individual’s sex, race, color, religion, age, disability, status as a veteran, or national or ethnic origin; nor does Yale discriminate on the basis of sexual orientation or gender identity or expression. Title IX of the Education Amendments of 1972 protects people from sex discrimination in educational programs and activities at institutions that receive federal financial assistance. Questions regarding Title IX may be referred to the University’s Title IX Coordinator, at TitleIX@yale.edu, or to the U.S. Department of Education, Office for Civil Rights, 8th Floor, Five Post Office Square, Boston MA 02109-3921. Telephone: 617.289.0111, Fax: 617.289.0150, TDD: 800.877.8339, or Email: firstname.lastname@example.org.
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