Research Medicare Coverage Analysis Specialist

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🐊 Florida, Nevada, +1 more states – Remote

🐊 Florida – Remote 🎰 Nevada – Remote 🏈 Ohio – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Cleveland Clinic

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Cleveland Clinic is a not-for-profit, multispecialty academic medical center located in Cleveland, Ohio. Founded in 1921, it integrates clinical and hospital care with research and education, earning a reputation as one of the largest and most respected hospitals in the country. The health system includes multiple facilities across Northeast Ohio and other locations globally, providing a wide range of specialized services such as cancer care, women's health, dermatology, and cardiovascular care. Cleveland Clinic is accredited by The Joint Commission, which underscores its commitment to high standards in healthcare delivery.

📋 Description

• Determine qualifying clinical trial status and perform detailed coverage analyses under NCD 310.1 and the Federal Clinical Trials Policy • Review clinical trial protocols, regulatory documents, clinical trial agreements, informed consent documents, FDA and CMS documents, and study budgets • Assess patient care items and services required by study protocols • Determine final billing designations for procedures within clinical research projects • Ensure compliant research billing practices • Research and apply federal, state, CMS, and professional practice guidelines for coverage determinations • Document coverage-analysis justifications with cited resources • Assist with claims review by applying appropriate CDM and/or CPT codes • Identify items and services billable to research sponsors • Collaborate with Principal Investigators, research teams, patient financial services, clinical research billing office, IRB, and research compliance • Maintain current knowledge of FDA and Medicare regulations and applicable state laws • Assist the MCA Director in developing tools and billing grids • Perform other duties as assigned

🎯 Requirements

• Bachelor’s degree in Healthcare Administration, Medical Coding, Auditing, Finance, Accounting, Nursing or a related field • In lieu of degree, six years of relevant experience in research billing, compliance, and/or direct involvement with sponsored clinical trials • Four years of relevant experience in research billing, compliance, and/or direct involvement with sponsored clinical trials • Ability to interpret and comprehend complex clinical research protocols, research contracts, study budgets and consent forms to extrapolate billing/coverage data • Strong organizational skills with ability to multi-task • Preferred: Ability to navigate CMS website • Preferred: Coding experience • Preferred: Scientific or healthcare background (i.e. Billing, clinical trials) • 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 • Must comply with personal protective equipment requirements as applicable

🏖️ Benefits

• Annual influenza vaccination or approved exemption required • Equal opportunity employment • Drug-free workplace • Controlled-substance testing following employment offers

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