Research Billing Coverage Analysis Coordinator

Job Description

Description

Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina.

Summary:

The Research Billing Coverage Analysis Coordinator will analyze protocol-driven clinical research services to ensure that both routine and research services are properly identified and billed in compliance with the Medicare Clinical Trial Policy, national and local laws and regulations, as well as institutional billing policies. The position will also meet with study teams to review the billing grid prior to study start up and collaborate with study teams to assess study readiness prior to activation. Under limited supervision, and with the latitude for initiative and independent judgment, performs, coordinates, and manages the creation and outsourcing of billing analysis in accordance with the Medicare Clinical Trial Policy, national and local laws, and regulations, as well as institutional billing policies. The BCA Analyst applies subject matter expertise to complex protocols. The documented analysis will serve as the basis for study budget creation and patient charge review once a research subject has completed corresponding visits at UNC Health facilities. The position will also meet with Principle Investigators/study teams to review the billing grid prior to study start up. These key research activities are a substantial part of the $1.3B UNC earns in Research activities across the University. This work impacts patients, faculty, staff, and all programs supported by these funds.

The ideal candidate for our Research Billing Coverage Analysis (BCA) Coordinator role is someone who thrives in a fast-paced clinical research environment and brings a strong understanding of research billing compliance, coverage analysis, and clinical trial operations. This individual should be comfortable reviewing and interpreting complex research protocols, informed consent forms, sponsor agreements, Medicare benefit policies, and National and Local Coverage Determinations (NCDs and LCDs) to ensure compliant and accurate billing practices in accordance with the Medicare Clinical Trial Policy (NCD 310.1).

Successful candidates have experience with clinical research billing workflows, coverage analysis calendars, budget development, and cross-functional collaboration with study teams, investigators, finance, and compliance stakeholders. Familiarity with CTMS platforms such as OnCore, Epic, and other healthcare or research systems is highly valued, along with working knowledge of coding concepts (CPT/HCPCS) and clinical trial startup processes.

We're looking for someone who is highly detail-oriented, organized, and able to interpret ambiguous information while communicating clearly and effectively across teams. Backgrounds in clinical research coordination, research administration, nursing or allied health, research finance, or healthcare revenue cycle operations are especially encouraged.

Responsibilities:

• Clinical Research Protocol Review: Review research protocols, sponsor agreements, informed consent forms and related documents. Analyze Medicare benefit policies, national and local coverage determinations, and review medical treatment guidelines related to study specific interventions and routine care. Create coverage analyses in accordance with Medicares Clinical Trial Policy (NCD 310.1) and assist research staff within the clinical departments with the interpretation of related guidance and their effect on research billing processes. Applies the appropriate Hospital and/or CPT codes for potentially billable items in the coverage analysis 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.
• Consultation on Research Billing Designations: Collaborate with the trial Principal Investigators and study team members to review any procedures that are not clear from the study documents and/or those representing a difference of coverage opinion. Work closely with the research team to conduct a thorough feasibility assessment using tools available.
• Consultation on Study Budgets: Assist in the creation of study budgets. Ensure that all treatment costs for clinical studies are included in the study budget and are appropriate and/or accurate. Assist audit and compliance departments during reviews and monitoring of clinical research billing.
• Document Preparation & Finalization: Provide clear documentation of the analysis that includes coverage determinations and supporting citations for the compliant and accurate categorization of all items and services.
• Healthcare Liaison: Serve as a liaison with the UNC Health Integrated Billing Office, identifying best practices and overseeing resolution of complex research billing issues. Work to resolve any billing questions from UNC Health Billing Office in a timely matter if a patients record is on a bill hold.
• Other duties as assigned by management to meet business needs.

Other Information

Education Requirements:

Bachelors degree or equivalent.

Licensure/Certification Requirements:

Professional Experience Requirements:

With a Bachelors degree, requires one (1) year of related experience.

With an Associates degree, requires five (5) years of related experience.

Knowledge/Skills/and Abilities Requirements:

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: Office of Clinical Research Operations

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: $31.04 - $44.62 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Remote

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: Yes

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.

UNC Health makes reasonable accommodations for applicants and employees religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email [email protected] if you need a reasonable accommodation to search and/or to apply for a career opportunity.