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Clinical Research Billing Analyst - Rush Corp Compliance Audit

Company: Rush University Medical Center
Location: Chicago
Posted on: January 15, 2021

Job Description:

Job Title: Clinical Research Billing Analyst - Rush Corp Compliance AuditDepartment: Corp Compliance AuditShift: 1stSpecialty: BillingJob Number: 2020-2576Date Posted: 09/23/2020Position Type: ResearchJob Qualifications:At Rush University Medical Center, we are committed to advancing scientific medical knowledge through research. We are revitalizing our medical centers with an emphasis on productivity, transparency and accountability. Are you looking to be a part of the exciting, always evolving and expanding new developments in research here at Rush University Medical Center? If this describes you, you may be the right candidate for the Clinical Research Billing Analyst position with the department of Corporate Compliance Audit.Position Highlights:This position conducts system wide audits as it relates to Clinical Research Billing Compliance to ensure that Rush University Medical Center is billing in accordance with federal and state regulations. This position reports directly to the Manager, of Clinical Research Billing Audit. This person will perform audits of clinical research processes as it relates to revenue cycle activities related to billing. The audit results will be utilized to assess and mitigate risk related to the development of coverage analyses, charge segregation, subject enrollment and compliance with Medicare coverage requirement. Responsible for individual projects and team projects as needed and is expected to function independently with minimal supervision and with a high level of accuracy and attention to detail. Exemplifies the Rush mission, vision and values and acts in accordance with Rush policies and procedures.Position Responsibilities:Develop an understanding of the operations, system processes, and procedures used in areas being audited.Compile information and/or prepare reports and analyses setting forth results of compliance audits with appropriate recommendations; perform subsequent audits to ensure complete and appropriate corrective action.Evaluate the adequacy of corrective action(s) to improve deficiencies.Audit and monitor clinical systems and processes for identifying research participantsIdentify and prioritize risk issues, working as a team on projects.Research government billing regulations, third party payer guidelines and prospective payment system, ICD-10-CM, CPT/HCPCS coding guidelines.Maintain an understanding of regulatory issues through seminars, training courses and regulatory literature.Develop audit tools for issue trackingCreate documentation tools and tip sheets to facilitate educationCoordinate education and training for all internal parties involved in the Clinical Research Billing process.Preform billing compliance audits to include routine audits, risk-based audits and special investigation audits.Analyze routine data/reports and denials from the billing process activities to identify trends, issues, and risk areas.Conduct audits of all human subject research protocols in accordance with the study's informed consent and agreement with the Sponsor.Perform audits of the coverage analyses in compliance with the Clinical Trial Agreement, Informed Consent Form, regulatory guidance and post award management to ensure there is a confident tool for claims reviewReview the accuracy of charges prior to, and after billing has occurred, to government and non-government payersAssess claims for clinical research billed to Medicare and ensure appropriate modifiers and diagnoses are included as required. Provide recommendations for improvements as required.Perform retrospective and prospective audits on a defined set of research claims/charges after billing to payers and research sponsorsInitiate targeted/probe audits as needed in response to suspected billing error(s).Other duties as related to the functions of this role.Required Position Qualifications:Bachelor's degree and four years of experience in a related field; or an equivalent combination of education and experienceExperience with or knowledge of billing (hospital, professional, clinical research)Experience with or knowledge of healthcare coding (CPT, ICD-10, DRG, HCPCS)Demonstrated knowledge of federal and state laws and regulations related to the provision and reimbursement of healthcare services, particularly clinical research billing and grant funding and managementDemonstrated knowledge of the Medicare Clinical Trial National Coverage Decision, general coverage analysis requirements, and financial and administrative requirements of third-party billing for clinical trialsPrefer experience in clinical research, familiarity with protocols, clinical trials, and clinical research studies.Strong analytical skillsSelf-starter and willingness to contribute where there is a need within the team.Demonstrated ability to work independently and to prioritize work responsibilities and effectively manage fluctuating workload demands.Excellent verbal and written communication and interpersonal skills.Ability to maintain strict standards of confidentiality in dealing with protected health information.Professional written, verbal, analytical, organizational, problem solving and presentational skills.Expertise in Microsoft Office applications, including: Excel, Access, Word, PowerPointPreferred Position Qualifications:Experience with EPIC and OnCoreCompany Highlights:Rush was recently ranked among the top 20 hospitals in the nation by U.S. News & World Report. Eleven Rush programs were recently ranked among the nation's best by U.S. News & World Report.Rush was recently ranked first for Quality and Accountability among US academic medical centers in a study conducted by the health care performance improvement company Vizient.The Association for the Accreditation of Human Research Protection Programs (AAHRPP) has awarded Rush full accreditation for three years. Rush is one of the first academic medical centers in Illinois to receive this accreditation. As an academic medical center, Rush University Medical Center in Chicago, Illinois, is committed to advancing medical knowledge through research. Investigators at Rush are involved in more than 1,600 projects, including hundreds of clinical studies to test the effectiveness and safety of new therapies and medical devices, as well as to expand scientific and medical knowledge. Rush University is home to one of the first medical colleges in the Midwest and one of the nation's top-ranked nursing colleges, as well as graduate programs in allied health, health systems management and biomedical research.Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.At Rush University Medical Center, we are committed to advancing scientific medical knowledge through research. We are revitalizing our medical centers with an emphasis on productivity, transparency and accountability. Are you looking to be a part of the exciting, always evolving and expanding new developments in research here at Rush University Medical Center? If this describes you, you may be the right candidate for the Clinical Research Billing Analyst position with the department of Corporate Compliance Audit.Position Highlights:This position conducts system wide audits as it relates to Clinical Research Billing Compliance to ensure that Rush University Medical Center is billing in accordance with federal and state regulations. This position reports directly to the Manager, of Clinical Research Billing Audit. This person will perform audits of clinical research processes as it relates to revenue cycle activities related to billing. The audit results will be utilized to assess and mitigate risk related to the development of coverage analyses, charge segregation, subject enrollment and compliance with Medicare coverage requirement. Responsible for individual projects and team projects as needed and is expected to function independently with minimal supervision and with a high level of accuracy and attention to detail. Exemplifies the Rush mission, vision and values and acts in accordance with Rush policies and procedures.Position Responsibilities:Develop an understanding of the operations, system processes, and procedures used in areas being audited.Compile information and/or prepare reports and analyses setting forth results of compliance audits with appropriate recommendations; perform subsequent audits to ensure complete and appropriate corrective action.Evaluate the adequacy of corrective action(s) to improve deficiencies.Audit and monitor clinical systems and processes for identifying research participantsIdentify and prioritize risk issues, working as a team on projects.Research government billing regulations, third party payer guidelines and prospective payment system, ICD-10-CM, CPT/HCPCS coding guidelines.Maintain an understanding of regulatory issues through seminars, training courses and regulatory literature.Develop audit tools for issue trackingCreate documentation tools and tip sheets to facilitate educationCoordinate education and training for all internal parties involved in the Clinical Research Billing process.Preform billing compliance audits to include routine audits, risk-based audits and special investigation audits.Analyze routine data/reports and denials from the billing process activities to identify trends, issues, and risk areas.Conduct audits of all human subject research protocols in accordance with the study's informed consent and agreement with the Sponsor.Perform audits of the coverage analyses in compliance with the Clinical Trial Agreement, Informed Consent Form, regulatory guidance and post award management to ensure there is a confident tool for claims reviewReview the accuracy of charges prior to, and after billing has occurred, to government and non-government payersAssess claims for clinical research billed to Medicare and ensure appropriate modifiers and diagnoses are included as required. Provide recommendations for improvements as required.Perform retrospective and prospective audits on a defined set of research claims/charges after billing to payers and research sponsorsInitiate targeted/probe audits as needed in response to suspected billing error(s).Other duties as related to the functions of this role.Required Position Qualifications:Bachelor's degree and four years of experience in a related field; or an equivalent combination of education and experienceExperience with or knowledge of billing (hospital, professional, clinical research)Experience with or knowledge of healthcare coding (CPT, ICD-10, DRG, HCPCS)Demonstrated knowledge of federal and state laws and regulations related to the provision and reimbursement of healthcare services, particularly clinical research billing and grant funding and managementDemonstrated knowledge of the Medicare Clinical Trial National Coverage Decision, general coverage analysis requirements, and financial and administrative requirements of third-party billing for clinical trialsPrefer experience in clinical research, familiarity with protocols, clinical trials, and clinical research studies.Strong analytical skillsSelf-starter and willingness to contribute where there is a need within the team.Demonstrated ability to work independently and to prioritize work responsibilities and effectively manage fluctuating workload demands.Excellent verbal and written communication and interpersonal skills.Ability to maintain strict standards of confidentiality in dealing with protected health information.Professional written, verbal, analytical, organizational, problem solving and presentational skills.Expertise in Microsoft Office applications, including: Excel, Access, Word, PowerPointPreferred Position Qualifications:Experience with EPIC and OnCoreCompany Highlights:Rush was recently ranked among the top 20 hospitals in the nation by U.S. News & World Report. Eleven Rush programs were recently ranked among the nation's best by U.S. News & World Report.Rush was recently ranked first for Quality and Accountability among US academic medical centers in a study conducted by the health care performance improvement company Vizient.The Association for the Accreditation of Human Research Protection Programs (AAHRPP) has awarded Rush full accreditation for three years. Rush is one of the first academic medical centers in Illinois to receive this accreditation. As an academic medical center, Rush University Medical Center in Chicago, Illinois, is committed to advancing medical knowledge through research. Investigators at Rush are involved in more than 1,600 projects, including hundreds of clinical studies to test the effectiveness and safety of new therapies and medical devices, as well as to expand scientific and medical knowledge. Rush University is home to one of the first medical colleges in the Midwest and one of the nation's top-ranked nursing colleges, as well as graduate programs in allied health, health systems management and biomedical research.Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.

Keywords: Rush University Medical Center, Chicago , Clinical Research Billing Analyst - Rush Corp Compliance Audit, Professions , Chicago, Illinois

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