Clinical Trial Reimbursement Specialist

Job Description

Job ID: 1186049
Employment Status: Full-Time
Your Career. Made Better.

BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and mid-Missouri regions. BJC serves patients and their families in urban, suburban and rural communities through its 15 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.


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Role Purpose

Review the protocol, informed consent, fully executed contract with budget to support the coverage analysis development per the master agreement and Medicare guidelines. These documents will be used to identify procedures required by the documents creating a billing matrix and assigning financial responsibility to the study or patient insurance. The billing matrix will be developed capturing all of the study services and timeframes including information from study documents to support billing compliance. Billing matrix will be provided to revenue management to split the claims to study and/or patient insurance. Applies defined policies and procedures to categorize or analyze departmental issues.


Responsibilities

  • Use critical thinking skills and demonstrates comprehensive understanding of research regulations/policies in administering processes to ensure clinical trial billing matrix; ensures compliance with regulatory requirements related to research billing, ensures compliance with the MOU/research agreements, validates completed information to ensure correct coding and billing for services and timeframes for each enrollee in the trials.
  • Perform detailed reviews of protocols, fully executed contracts with budgets, informed consent documents, and other supporting information to conduct comprehensive coverage analysis documenting final recommendations for billing.
  • Analyze routine research billing compliance audits of research accounts to ensure billing compliance per study documents. Respond to questions from revenue management timely including review of charges and billing matrix including working and confirming with study team that research accounts and patient insurance are being billed appropriately. Notify revenue management of any errors in billing matrix to review all subjects at risk.
  • Understands the clinical trial pricing strategy to provide research teams information to prepare budgets and/or explain annual rate structures. Liaison to BJC entities to ensure clinical trials and enrollees are identified for trials not supported by billing matrix.
  • Maintain organizational workflow process to build billing matrix based on department priority working closely with research teams and liaisons. Meet weekly productivity measurement expectations are met to ensure timely and accurate filing of claims.

  • Minimum Requirements

     

    Degree

  • Bachelor's Degree
  • - HIM/Nursing/related

     

    Experience

  • 2-5 years
  •  

    Supervisor Experience

  • No Experience
  •  

    Licenses & Certifications

  • RN or RHIA

  • Benefits Statement

    Note: not all benefits apply to all openings

    -  Comprehensive medical, dental, life insurance, and disability plan options
    -  Pension Plan*/403(b) Plan
    -  401(k) plan
    -  Tuition Assistance
    -  Health Care and Dependent Care Reimbursement Accounts
    -  On-Site Fitness Center (depending on location)
    -  Paid Time Off Program for vacation, holiday and sick time

    *Pension does not apply to Memorial Hospital, Memorial Hospital East, Memorial Medical Group, Alton Memorial or Parkland Health Center


    Legal Statement

    The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job.

     

    Equal Opportunity Employer