Clinical Trial Coverage Analyst

Sutter Health

Sacramento, CA

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JOB DETAILS

SALARY

$94,848–$142,272 Per Year

SKILLS

Administrative Skills, Alliance/Partner Management, Analysis Skills, Billing, Billing Records, Brochures, Budgeting, Clinical Assessment, Clinical Medicine, Clinical Practices/Protocols, Clinical Research, Clinical Study Publications, Clinical Support, Clinical Trial, Coaching, Communication Skills, Computer Skills, Current Procedural Terminology (CPT), Detail Oriented, Documentation, Establish Priorities, FDA (Food and Drug Administration), Financial Support, GCP (Good Clinical Practices), Healthcare Common Procedure Coding System (HCPCS), Insurance, Interpersonal Skills, Leadership, Legal, Medical Coding, Medical Protocols, Medical Records, Medicare, Mentoring, Microsoft Excel, Microsoft Outlook, Microsoft Word, Multitasking, Operations Research, Organizational Skills, Presentation/Verbal Skills, Problem Solving Skills, Protocol Analysis, Regulatory Compliance, Reimbursement, Research Protocols, Service Delivery, Support Documentation, Team Lead/Manager, Team Player, Third-Party Payer, Time Management, Writing Skills

LOCATION

Sacramento, CA

POSTED

Today

We are so glad you are interested in joining Sutter Health!

Organization:

SHSO-Sutter Health System Office-Valley

Position Overview:

Responsible for determining if a study is a qualifying clinical trial, and performing the initial coverage analysis review by analyzing individual research protocol clinical services to assure federally compliant billing and reimbursement. Ensuring complete submission of documents required to conduct a coverage analysis and activate a study and submitting notification of participation letter to Noridian (MAC) when needed. Determining and documenting billing support for clinical items by reviewing the protocol, investigator brochures, sponsor budget, sponsor proposed contract, and consent template, the evidence of medical necessity justifications, and appropriate payers of protocol-specific services and federally required research-related claims modifications for service payment by insurance. Conducting the final review and analysis of study documents to assure all study-related documents are harmonized. Interpreting Medicare/Medicaid coverage decisions, national guidelines as they apply to specific clinical trial medical items and services. Supporting Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) billing determinations of clinical trial items and services and applying all applicable local coverage decisions, national and local coverage determinations, and third-party payer rules for clinical trial coverage analyses. Interfacing with various Sutter Health research affiliates, administrative staff, principal investigators, essential partners, and clinical trial sponsors regarding reimbursement for research services. Implementing an integrated support function that standardizes the administrative and financial support functions of clinical trial billing compliance thereby improving service to the Sutter Health research community and providing an increased level of research compliance.

Job Description :

EDUCATION:

+ Bachelors or equivalent education/experience

TYPICAL EXPERIENCE:

+ 5 years recent relevant experience

SKILLS AND KNOWLEDGE:

+ Demonstrated knowledge of clinical research concepts, good clinical practices and regulatory compliance

+ Knowledge of Medicare benefit categories, statutory exclusions, and national and local coverage determination and of national medical practice guidelines, Food and Drug Administration investigational drug and device research

+ Knowledge of medical coding, protocol visit span allowances, protocol-specified clinical services, and basic research study demographics of clinical research financial activities and documentation required before study initiation, including research protocol, internal budget, sponsor contract and budget, and consent template

+ Demonstrated written, oral, electronic communication; presentation and interpersonal skills

+ Ability to use multiple technical systems as intended; ability to collaborate across revenue cycle, compliance, and research operations teams; and attention to detail

+ Analytical and computer skills, including proficiency in Microsoft Word, Outlook, and Excel

+ Ability to work independently and to accept responsibility for complex and sensitive decision making as it relates to the position

+ Outstanding organization skills to manage many competing timetables and responsibilities

+ Demonstrated leadership skills, including team building, and coaching/mentoring with the ability to motivate and engage others

+ Ability to build and establish effective working partnership with employees, peers and/or leaders to achieve business objectives

+ Verbal and written communication, and interpersonal skills

+ Organizational and time management skills, with the ability to prioritize multiple projects while delivering quality service and achieving business results

+ Demonstrates tactical and analytical thinking and planning skills, and is able to develop plan to accomplish objectives, identify obstacles and resolve operational issues

+ Demonstrated skill in communicating and collaborating with Sutter Health essential partners (Legal Services, ECS, SHIRB) and research institute personnel.

Job Shift:

Days

Schedule:

Full Time

Days of the Week:

Monday - Friday

Weekend Requirements:

None

Benefits:

Yes

Unions:

No

Position Status:

Exempt

Weekly Hours:

40

Employee Status:

Regular

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $94,848.00 to $142,272.00 / annual salary

_The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package._

About the Company

Sutter Health

Sutter Health has a long history in California. Some of our facilities have been providing care in the communities we serve for more than 100 years. Today, we’re proud to partner with more than 12,000 doctors to care for more than 3 million people.

We’re inspired by our Northern California community and work tirelessly to deliver top-rated, affordable healthcare. Doctors, hospitals, care teams and employees in the Sutter Health network are always looking for new, meaningful ways to care for you and your loved ones. We believe that every moment matters when it comes to helping you live a longer, healthier and happier life.

Our not-for-profit network delivers top-rated, personalized care in more than 100 Northern California communities. Recently ranked among the Top 15 Health Systems in the nation by Truven Health Analytics™, our team of more than 50,000 doctors, employees and volunteers partner to spread innovation, improve access to healthcare services and put our patients’ needs first—all to achieve the highest levels of quality, access and affordability.

COMPANY SIZE

10,000 employees or more

INDUSTRY

Healthcare Services

EMPLOYEE BENEFITS

Professional Development, 401K, Flexible Spending Accounts, Retirement / Pension Plans, Tuition Reimbursement, Life Insurance

FOUNDED

1921

WEBSITE

https://jobs.sutterhealth.org/

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