Coverage Analysis, Financial Quality Specialist

Job not on LinkedIn

🔥 3 minutes ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $74.7k - $123.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💸 Financial Planning and Analysis (FP&A)

🦅 H1B Visa Sponsor

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👻 Ghost score 0%

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Brown Medicine

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1995

🏥 Healthcare

📚 Education

🔬 Science

Healthcare • Education • Science

Brown Medicine is a medical practice group that has joined Brown Health Medical Group, providing integrated outpatient and specialty care across a network of providers under a single electronic health record. It offers patient-facing services such as primary and specialty care, televisits, and online patient portals (transitioning to MyChart), as well as administrative and billing support, and is affiliated with Brown University Health and the Warren Alpert Medical School.

📋 Description

• Serves as the primary quality reviewer for Coverage Analyses supporting clinical trial activation • Reviews Coverage Analyses for accuracy, consistency, billing designation integrity, regulatory compliance, and alignment with study requirements • Evaluates Coverage Analyses against study protocols, schedules of events, intake documentation, Medicare coverage guidance, institutional requirements, and related study documents • Identifies and resolves discrepancies between Coverage Analyses, internal budgets, sponsor budgets, and study documentation • Coordinates corrections with vendors, study teams, and applicable stakeholders • Conducts quality review of negotiated sponsor budgets before investigator or departmental approval • Verifies negotiated budget terms, calculations, institutional fees, pass-through costs, and sponsor payment responsibilities • Confirms alignment between final negotiated sponsor budgets, internal budgets, and approved Coverage Analyses • Reviews participant compensation and reimbursement structures and budget-related protocol amendments • Participates in CCRM intake meetings to identify financial, billing, operational, participant compensation, and payer responsibility considerations • Supports study activation by ensuring required Coverage Analysis, budget quality, participant compensation, and financial quality reviews are completed • Provides billing compliance consultation and cross-coverage support for research billing review functions • Assists with investigation and resolution of research billing discrepancies and compliance concerns • Tracks quality review findings, billing review trends, and recurring issue patterns • Develops recommendations for process improvement, training, and risk reduction • Maintains standard operating procedures, guidance documents, training materials, and review tools • Provides education and training on Coverage Analysis, research billing compliance, participant compensation, and financial quality review • Participates in workgroups, quality improvement initiatives, workflow redesign, operational improvement efforts, internal audits, and quality assurance activities • Maintains documentation and serves as liaison with external vendors regarding quality issues

🎯 Requirements

• Advanced knowledge of clinical research operations, Coverage Analysis methodology, clinical research billing compliance, sponsor budget development, research finance principles, and study activation workflows • Working knowledge of Medicare coverage guidance, qualifying clinical trial requirements, participant compensation practices, clinical trial agreements, and clinical research financial operations • Demonstrated ability to evaluate complex research documents, identify discrepancies, assess risk, and recommend practical solutions • Strong analytical, organizational, and problem-solving skills • Ability to independently manage multiple priorities while maintaining accuracy and attention to detail • Excellent written and verbal communication skills • Ability to effectively collaborate with investigators, research personnel, vendors, finance staff, and operational stakeholders • Proficiency with clinical research technology platforms including OnCore, Microsoft Office applications, and related reporting and data-management tools • Bachelor's degree in Clinical Research, Healthcare Administration, Finance, Business Administration, Health Informatics, or a related field required • Minimum of five (5) years of progressively responsible experience in clinical research administration, Coverage Analysis, clinical research billing compliance, research finance, budget development, financial review, or related research operations activities • Experience reviewing Coverage Analyses, sponsor budgets, research billing determinations, research finance activities, or related compliance functions strongly preferred • Clinical research operations experience, including experience as a research coordinator, regulatory specialist, research administrator, or related research role preferred • Experience working in an academic medical center, healthcare system, pharmaceutical company, contract research organization, or research environment preferred • Equivalent combinations of education and experience may be considered