The mission of the YCCI Coverage Analyst is to provide an institutional safeguard to ensure clinical research study budgets comply with applicable federal, state and local laws, national guidelines, and regulations related to clinical research budgeting and billing while streamlining the clinical research study activation timeline.
Under the direction of the Associate Director, the CA will be responsible for performing a comprehensive Medicare Coverage Analysis in accordance with Medicare's Clinical Trial Policy (NCD 310.1) as well as medical association guidelines, national and local coverage determinations, nationally recognized peer-reviewed publications and professional practice guidelines on clinical research protocols with billable services. The CA will ensure accurate determinations of research patient billing compliance to mitigate institutional risk. The incumbent will maintain comprehensive documentation of all Medicare Coverage Analysis grids and systems for tracking in the institutional Clinical Trials Management System, OnCore. Be responsible for sign off on all Medicare Coverage Analysis grids by assisting research faculty with the interpretation of related guidance and their effect on research billing processes, as needed. Exemplifies the YSM mission, vision and values and acts in accordance with the YSM Clinical Research Billing and Compliance Policy and procedures. Maintains, utilizes and updates data collection in OnCore for use in gathering and compiling information, preparing reports and analyses, as required.
The ideal candidate will establish and maintain cooperative and mutually supportive working relationships with YSM faculty, administrators, research staff, and sponsoring agencies and companies. The ideal candidate will also be flexible and prioritize within an ever-changing, service-oriented environment and appropriately complete individual assignments while also working effectively within a team and on team projects.
- Utilize and review study specific Medicare Qualifying determinations (MQT) as well as the billing grids in OnCore.
- Perform comprehensive and independent review of all documents related to research study funding, including the research study budget, protocol, contract, informed consent, and other supporting core documents.
- Analyze, interpret, and apply Medicare Coverage rules; identify services as non-covered research-only care, usual routine care, expanded care and investigational items and services; advise investigators and study staff on applicable regulatory requirements.
- Analyze, interpret, and apply internal and external research billing policies, assisting faculty, study staff, and clinical managers in determining applicable review requirements and facilitating timely budget approval
- Provide excellent customer service and accurate guidance to clinical research budget analysts regarding clinical research budgeting and billing policies and procedures.
- Work collaboratively with financial management staff, and the research compliance staff to ensure the accuracy of data entered in the billing compliance risk assessment as well as the financial console in OnCore, to ensure accuracy.
Required Education and Experience
Bachelor’s Degree and four years of related experience or equivalent combination of education and experience.
Required Skill/Ability 1:
Strong working knowledge of medical terminology. Proven experience collaboratively with faculty, administrators, and staff in an academic medical center, health care or university environment.
Required Skill/Ability 2:
Proven ability to communicate positively and effectively in all situations, professionally participate in discussions regarding the Yale clinical research process.
Required Skill/Ability 3:
Ability to follow instructions, meet expected turnaround times, monitor, analyze, and improve processes in a time-sensitive environment.
Required Skill/Ability 4:
Excellent written and verbal communications skills. Strong organizational skills and attention to detail are a must. Excellent analytical, problem-solving and decision-making skills. Ability to learn and utilize other software and healthcare technology related systems, and web-based tools.
Required Skill/Ability 5:
Maintain excellent punctuality and attendance, and remain an outstanding professional, collaborative, and customer service-oriented representative.
Preferred Education, Experience and Skills:
CPT, HCPCS, and ICD-10 working experience. Relevant coding certification. Coverage Analysis Certification and/or confirmation of formal training. Current Procedural Coding Certification (AAPC). Experience working in OnCore system as it relates to clinical research billing compliance/ finance. Working knowledge of the full range of pre-award activities related to clinical trial research.
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.
Yale University is a tobacco-free campus