Research Specialist, ONC - (Coverage Analyst) at UPMC

Pittsburgh, Pennsylvania, United States -

Full Time

Start Date

Immediate

Expiry Date

23 Jun, 26

Salary

0.0

Posted On

25 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Coverage Analysis, Financial Compliance, Clinical Trial Budgeting, Medicare Coverage Rules, EPIC EHR, OnCore CTMS, Charge Segregation, CDM Codes, CPT Codes, Claims Review, Protocol Review, Analytical Skills, Organizational Skills, Time Management, Communication Skills

Industry

Hospitals and Health Care

Description

Purpose: UPMC Hillman Cancer Center is internationally recognized for its leadership in the prevention, detection, diagnosis, and treatment of cancer and is the region's only comprehensive cancer center designated by the National Cancer Institute. As the preeminent institution in western Pennsylvania for the delivery of cancer care, the performance of basic, translational, and clinical research, and the education of the next generation of cancer researchers and physicians, UPMC Hillman Cancer Center is exceptionally well-positioned to contribute to the global effort to reduce the burden of cancer. UPMC Hillman Cancer Center is currently hiring a regular full-time Research Specialist - Coverage Analyst, ONC to help support the Oncology Clinical Research Services team located at the Hillman Cancer Center in Shadyside/Pittsburgh, PA. This role will support the Financial Compliance team working Monday through Friday daylight hours with a remote schedule. This position is necessary to build clinical trial budgets and coverage analysis for clinical trials. The Clinical Trial Coverage Analyst is responsible for ensuring the financial 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 and other insurance 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. The Clinical Research Services (CRS) team is made up of nearly 200 staff members who facilitate the development, implementation, coordination, internal data monitoring, and completion of oncology-focused trials at Hillman. These trials include institutional (investigator-initiated), multi-center cooperative group/National Clinical Trial Network (NCTN), consortium, and industry-sponsored trials. Using a disease-specific centers model for conducting clinical trials, CRS provides study development and implementation assistance, submissions to the FDA, IRB processing, patient recruitment, study coordination, study-specific training, data collection, and specimen collection and processing. Responsibilities: Perform detailed coverage analysis of clinical trial protocols to distinguish billable versus non-billable items and services. Ensure 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. Collaborate with clinical research teams to develop accurate study budgets based on coverage analysis findings. 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. Synchronizes the final coverage analysis with appropriate final study documents. Maintain up-to-date knowledge of healthcare billing regulations, payer policies, and clinical trial reimbursement guidelines. Assist with the resolution of billing discrepancies related to clinical trial services. Provide training to research staff on coverage analysis and compliant billing practices. Bachelor's degree in health-related field. 3 years of experience in clinical trials. 1 year of experience in Medicare coverage determination preferred. Knowledge of clinical research protocol and budgeting is required. Excellent analytical skills with attention to detail. Strong organizational and time management skills. Excellent communication and interpersonal 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: Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran

Responsibilities

The specialist performs detailed coverage analysis of clinical trial protocols to distinguish billable versus non-billable items, ensuring compliance with Medicare and other payer regulations. This involves applying appropriate codes, collaborating on study budgets, and documenting costs to be covered by sponsors versus payers.