Payments and Research Revenue Specialist

About the role

The job provides professional support and solves straightforward problems in projects related to revenue cycle operations, including activities related to charging, billing, and collecting. It coordinates the management of successful billing and compliance activities with department managerial and executive staff.

Responsibilities

• Ensuring research revenue (grants, clinical trial payments) is allocated to correct study accounts or cost centers as designated in EMR and accounting systems.
• Accurately adjusting payments to ensure balanced accounts.
• Verifying that research funds received align with sponsor agreements, budget proposals, and internal tracking systems.
• Identifying and documenting denied payments, including underpayments or overpayments from research sponsors.
• Collaborating with research administration, grants management, and revenue cycle teams to resolve complex issues related to research revenue claims or payment delays.
• Investigating unapplied cash, payment variances, unidentified deposits, and unapplied research revenue.
• Working with internal research finance, grants management, and clinical trials offices to resolve research account discrepancies.
• Responding to inquiries from clinical departments, research investigators, grants offices, and sponsors about posted payments and account statuses.
• Collaborating with billing, coding, registration, research administration, grant management, and IT departments to ensure financial data integrity in the EMR and research management systems.
• Supporting audits by providing payment records, reconciliations, and research revenue documentation as needed.
• Generating cash application and reconciliation reports for management, including distinct reporting for research revenue streams (grants, trials, contracts).
• Maintaining thorough documentation for clinical and research payments for compliance and audit requirements.
• Ensuring adherence to institutional, federal (e.g., HIPAA, NIH regulations), and sponsor policies regarding payment processing and research revenue documentation.
• Staying current on EMR upgrades and best practices relating to both healthcare and research finance.
• Participating in process improvement initiatives for more efficient cash and research revenue application.
• Assisting with EMR system enhancements and providing training related to research revenue cash application processes.
• Monitoring EMR workqueues for outstanding payment postings, denials, unapplied cash, and research revenue items.
• Resolving items in workqueues promptly, ensuring accurate and timely cash application for both clinical and research accounts.
• Updating, maintaining, and clearing workqueue tasks to prevent backlog and ensure up-to-date account status.
• Communicating with relevant stakeholders to resolve account issues flagged in EMR workqueues.
• Assisting in configuring, testing, and optimizing EMR workqueue rules and workflows for cash application and research revenue tasks.
• Providing reconciliation documents, statement generation, and clarification on both clinical and research revenue transactions.
• Has a moderate/solid understanding of coding procedures, workflow issues, billing infrastructure, and performance of Clinical Revenue staff.
• Informs department administrators, physicians, and Coder/Abstractors of regulatory changes.
• Participates and may lead in training sessions, performing audits, and promoting an understanding of procedures, policies, and expectations in promotion of compliance efforts.
• Performs other related work as needed.

Qualifications

• Minimum requirements include a college or university degree in related field.
• Minimum requirements include knowledge and skills developed through 2-5 years of work experience in a related job discipline.

Preferred Qualifications

• Experience 2-4 years’ experience with healthcare clinical research billing preferably in academic medical setting, clinical research management, health system operations.
• Experience with Epic Research Billing functions.
• Experience with a Clinical Trial Management system (CTMS) preferably OnCore, financial software, ERP systems.
• Accounting and finance experience strongly preferred.
• Knowledge of the Medicare Clinical Trials Policy and other federal, state and institutional clinical research regulations.
• Expertise in CPT, Modifiers, ICD, and PCS codes to support billing and compliance efforts.
• Strong knowledge of clinical trial contracting, revenue recognition principles, and relevant regulatory guidelines (e.g., ICH-GCP).
• Excellent attention to detail and analytical skills, with a focus on accuracy in financial operations.
• Strong communication and interpersonal skills for effective collaboration with cross-functional teams and external partners.