Research Specialist, ONC - (Coverage Analyst)

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.
• Synchronize 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.
• Aid in the resolution of billing discrepancies related to clinical trial services.
• Provide training to research staff on coverage analysis and compliant billing practices.

Requirements

• Bachelor's degree in a 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 (a plus).