Sr. Medicare Coverage Analyst

About the role

The Medicare Coverage Analyst (MCA) is responsible for reviewing clinical research protocols, Informed Consent Forms, Clinical Trial Agreements, and other relevant study-related documents to create a coverage analysis/billing guide. The coverage analysis indicates which medical procedures/services may be 'Routine Cost' and billable to patient insurance and which should be billed to the study sponsor.

Responsibilities

• Determines whether proposed clinical research studies are a Qualifying Clinical Trial as defined by the Medicare Clinical Trial Policy (NCD 310.1) and designates medical procedures/services based on relevant regulations and determinations.
• Mentors/trains junior team members.
• Applies subject matter expertise to complex protocols.
• Serves as National and Local Coverage Determination (LCD and NCD) subject matter expert – disseminating changes to Medicare payor policy to other members of the MCA team.
• Trips and prioritizes coverage analysis workflow based on institutional need across disease centers – communicates MCA execution timelines to study teams and external stakeholders.
• Serves as the primary point of contact for urgent protocol amendments with budgetary and MCA impact, prioritizes and executes in narrow timelines.
• Interfaces with study team and principal investigators prior to protocol submission to assist with MCA determinations/study design.
• Independently interfaces with sponsors and sponsor representatives to resolve discrepancies in specific protocol assessments.

Requirements

• Bachelor's degree or RN credential.
• 5 years of experience in Medicare coverage analysis.
• Experience with research activities in an academic medical center.
• Experience with clinical trials management systems (CTMS).
• CPT/DRG coding experience is preferred.

Qualifications

• Understanding of research activity in an academic medical center.
• Knowledge of billing compliance and Medicare regulations/policy, applicable federal, state, and local laws, rules, regulations and policies and institutional policies and standard operating procedures.
• Knowledge of clinical research budgeting and the clinical trial life cycle: study start-up through study closure.
• Knowledge of clinical trials management system (CTMS).

Skills

• Ability to independently facilitate outreach/communication between study team and sponsor.

Benefits

Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life-changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS, and related diseases. We strive to create an inclusive, diverse, and equitable environment where we provide compassionate and comprehensive care to patients of all backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we educate tomorrow's physician/researchers, and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.

Pay

$77,500.00 - $90,400.00