Note: The job is a remote job and is open to candidates in USA. Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. The Medicare Coverage Analyst is responsible for reviewing clinical research protocols and determining which medical procedures/services are billable to patient insurance and which should be billed to the study sponsor.
Responsibilities
- Mentors and trains junior MCA staff, provides second-level review of junior staff determinations
- Creates coverage analysis grids for complex protocols
- Serves as National and Local Coverage Determination (LCD and NCD) subject matter expert – disseminating changes to Medicare payor policy to other members of the MCA team
- Triages and prioritizes coverage analysis workflow based on institutional need across disease centers – communicates MCA execution timelines to study teams and external stakeholders
- Serves as the primary point of contact for urgent protocol amendments with budgetary and MCA impact, prioritizes and executes in narrow timelines
- Independently interfaces with sponsors and sponsor representatives to resolve discrepancies in specific protocol assessments
- Interfaces with study team and principal investigators prior to protocol submission to assist with MCA determinations/study design
Skills
- Understanding of research activity in an academic medical center
- Knowledge of billing compliance and Medicare regulations/policy, applicable federal, state, and local laws, rules, regulations and policies and institutional policies and standard operating procedures
- Knowledge of clinical research budgeting and the clinical trial life cycle: study start-up through study closure
- Knowledge of clinical trials management system (CTMS)
- Ability to independently facilitate outreach/communication between study team and sponsor
- The position requires a bachelor's degree or RN credential
- 5 years of experience in Medicare coverage analysis
- Candidates should have experience with research activities in an academic medical center
- Working with clinical trials management systems (CTMS)
- CPT/DRG coding experience is preferred
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