Research Specialist - Coverage Analyst at UPMC

Pittsburgh, Pennsylvania, United States -

Full Time

Start Date

Immediate

Expiry Date

20 Mar, 26

Salary

0.0

Posted On

20 Dec, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Trials, Billing Compliance, Coverage Analysis, Healthcare Regulations, CPT Coding, Budgeting, Communication Skills, Analytical Skills, Organizational Skills, Time Management, Team Collaboration, Emotional Intelligence, Research Protocol, Financial Planning, Training, Problem Solving

Industry

Hospitals and Health Care

Description

Purpose: The Clinical Trial Coverage Analyst is responsible for ensuring the billing compliance and proper coverage of clinical trial procedures. This role involves reviewing clinical trial protocols to determine what is billable to third-party payers, ensuring alignment with Medicare coverage rules, and identifying study-related costs that should be covered by the study sponsor. The specialist collaborates with clinical research teams, finance departments, and compliance to ensure accurate financial planning and billing for clinical trials. This position works with various systems including EPIC EHR and OnCore CTMS for the purpose of segregating charges to ensure compliant billing for research services as well as providing pricing for budgeting purposes. Please note that this position is in-office three days per week. Responsibilities: Performs detailed coverage analysis of clinical trial protocols to distinguish billable versus non-billable items and services. Synchronizes final coverage analysis with appropriate final study documents. Maintain up-to-date knowledge of healthcare billing regulations, payer policies, and clinical trial reimbursement guidelines. Ensures compliance with Medicare's Clinical Trial Policy and other payer regulations related to clinical research billing. Applies the appropriate CDM and/or CPT codes for potentially billable items in the coverage analysis in order to assist in the management of claims review, as well as identifying items that are to be billed to the sponsor via the budgeting and contract teams. Collaborates with clinical research study teams to develop accurate study budgets based on coverage analysis findings and drives operational alignment up to study activation. Aligns coverage determinations within OnCore. Identify and document which study costs should be covered by the study sponsor versus the payer. Communicate findings to clinical research coordinators, investigators, and financial teams. Assist with the resolution of billing discrepancies related to clinical trial services. Provide training to research study teams on coverage analysis and compliant billing practices. *Performs in accordance with system-wide competencies/behaviors. *Performs other duties as assigned. Bachelors degree in health related field. 3 years of experience in clinical trials, pre-award research administration a plus. Knowledge of pre-award approval lifecycle. Knowledge of clinical research protocol and budgeting. Excellent analytical skills with attention to detail. High emotional intelligence, writing and excellent communication and interpersonal skills. Strong organizational and time management skills. Ability to work independently and as part of a team. Clinical Research Professional Certification or related certification is a plus. Licensure, Certifications, and Clearances: UPMC is an Equal Opportunity Employer/Disability/Veteran

Responsibilities

The Clinical Trial Coverage Analyst performs detailed coverage analysis of clinical trial protocols to distinguish billable versus non-billable items and services. They collaborate with clinical research teams and finance departments to ensure accurate financial planning and billing for clinical trials.