Note: The job is a remote job and is open to candidates in USA. Vitalief Inc. is a consulting and professional services firm supporting clinical research sites, sponsors, and CROs. The Clinical Trials Medicare Coverage Analyst will conduct Medicare Coverage Analyses for oncology and non-oncology clinical trials, ensure compliance with CMS regulations, maintain OnCore calendar builds, and advise cross-functional stakeholders on billing decisions and risks.
Responsibilities
- Conduct Medicare Coverage Analyses (MCA) for a mixture of oncology and non-oncology clinical trial protocols identifying which procedures and services are billable to Medicare versus those considered research related
- Review clinical trial protocols, schedules of events, and informed consent forms to ensure billing compliance with CMS regulations
- Develop, maintain, and validate OnCore calendar builds for clinical trial visits, procedures, and study milestones
- Collaborate with cross-functional teams including Clinical Operations, Finance, Regulatory, and Study Teams to provide guidance and clarification on coverage decisions
- Prepare and maintain coverage analysis documentation, summary tables, and billing justification reports for both internal and external stakeholders
- Serve as a subject matter expert for Medicare coverage rules, assisting study teams in identifying potential billing risks and providing actionable recommendations
- Support internal and external audits, ensuring all coverage decisions are well-documented and compliant with federal and sponsor requirements
- Keep current with CMS updates and industry best practices, applying knowledge to optimize coverage analyses and study operations
Skills
- Bachelor's degree in Healthcare Administration, Medical Coding, Auditing, Finance, Accounting, Nursing, or a related field
- Minimum 2 years of Medicare Coverage Analysis experience supporting clinical research studies for an Academic Medical Center (AMC) or health (hospital) system
- Must have experience working on oncology clinical trial protocols
- Hands-on experience developing, maintaining, and validating OnCore calendar builds for clinical trial visits, procedures, and study milestones is preferred – but not required as training will be provided
- Strong understanding of CMS guidelines, Medicare billing compliance, and clinical trial operations
- Demonstrated ability to work independently and manage multiple protocols and deadlines simultaneously
- Exceptional attention to detail, analytical skills, and problem-solving abilities
- Strong written and verbal communication skills, with the ability to explain complex billing concepts to non-technical stakeholders
- Comfortable working in a fully remote environment, collaborating effectively with distributed teams across multiple locations
- Proficiency in document and data management tools, including Microsoft Word, Excel, PowerPoint, Adobe, Teams, and SharePoint
- Standing, sitting, walking, visual perception, talking and hearing. Lifting up to 20lbs
Benefits
- 20 PTO days
- 9 paid holidays
- Company-paid life insurance
- Short- and long-term disability
- 401(k)-retirement plan
- Robust healthcare options
- 100% remote position
Company Overview