Director Research Medicare Coverage Analysis
Join Cleveland Clinic’s Main Campus where research and surgery are advanced, technology is leading-edge, patient care is world-class, and caregivers are family. Cleveland Clinic is recognized as one of the top hospitals in the country. You will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.
Research is a big part of the mission of the Cleveland Clinic. This position will work collaboratively with the institutes and research billing office to create a Medicare coverage analysis billing grid for research studies with a patient care billing component. This is a high-level position to ensure compliance with research billing and mitigate our risks of improper billing and will help standardize the process for coverage analysis for the Cleveland Clinic.
A caregiver in this position works 8:00am—5:00pm.
A caregiver who excels in this role will:
Manage and operate all administrative functions performed by the research Medicare coverage analysis team.
Serve as the subject matter expert for the MCA Office and is responsible for determining qualifying clinical trial status and performing detailed coverage analysis as required by NCD 310.1 and the Federal Clinical Trials Policy (CTP).
Ensure research billing practices are compliant by reviewing clinical trial protocols and related regulatory documents and agreements.
Assist all patient care items and service required for each study protocol.
Research and apply policies from various sources such as federal, state, CMS website, and professional practice guidelines in making coverage determinations.
Document justification for coverage analysis by citing specific resources for coverage determinations.
Direct the work activities of all research coverage analysts working in the section ensuring polices from various sources are followed.
Interview, hire, orient, and train staff.
Evaluate performance and provide feedback.
Make personnel action recommendations (e.g., promotions, transfers, disciplinary, discharge)
Review and approve MCA determinations performed by MCA analysts.
Assist in managing claims review by applying the appropriate CDM and/or CPT codes for potentially billable items and services and identifying items and services billable to the research sponsor.
Collaborate and communicate effectively as MCA subject matter expert with the Principal Investigator and research team, patient financial services, clinical research billing office, IRB, and research compliance related to Medicare coverage analysis issues and determinations.
Keep current on FDA and Medicare regulations and state laws that apply to clinical trials research billing and trains MCA analysts.
Generate policies and procedures related to Medicare coverage analysis for the Cleveland Clinic Health System.
Develop tools and billing grids for the Medicare coverage analysis process.
Minimum qualifications for the ideal future caregiver include:
Bachelor’s degree in healthcare administration, medical coding, auditing, finance, accounting, nursing, or a related field.
Six years of clinical research experience and an additional four years of management experience (10 years’ experience total).
Knowledge of billing compliance and Medicare regulations.
Excellent oral and written communication skills and can effectively communicate as the MCA subject matter expert with the Principal Investigator, research team, central offices and study Sponsor.
Interpret and comprehend complex clinical research protocols, interpret research contracts, study budgets and consent forms to extrapolate billing/coverage data.
Strong organizational skills with ability to multi-task.
Can manage high volume workload and meet established deadlines.
Preferred qualifications for the ideal future caregiver include:
Master’s in business or healthcare administration.
Overall experience and knowledge in coding with CPT.
Our caregivers continue to create the best outcomes for our patients across each of our facilities. Click the link and see how we’re dedicated to providing what matters most to you: https://jobs.clevelandclinic.org/benefits-2/
Physical Requirements:
Ability to perform work in a stationary position for extended periods.
Ability to operate a computer and other office equipment.
Ability to communicate effectively and exchange accurate information.
Ability to travel throughout the health system with occasional meetings with the Principal
Investigator and research teams and/or central offices.
Personal Protective Equipment:
Follows standard precautions using personal protective equipment as required for procedures.
The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances.
Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.
Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.
If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration: https://info.flclearinghouse.com/
Please review the Equal Employment Opportunity poster.
Cleveland Clinic is pleased to be an equal employment opportunity employer.
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