Sutter Health Clinical Trials Budget and Coverage Analyst in Walnut Creek, California
The position is responsible for the analysis of individual research protocol clinical services to assure federally compliant billing and reimbursement. The position determines the appropriate payers of protocol-specific services and federally required research-related claims modifications for service payment by insurance. The incumbent interprets Medicare/Medicaid coverage decisions and national guidelines as they apply to specific clinical trial budget medical services. This position will be responsible for coding study services and applying all applicable local coverage decisions, national coverage decisions, and third party payer rules. Development and negotiation of clinical trial budgets, working with the applicable research entity and principal investigator to optimize cost recovery for Sutter is an additional focus of this position . The position interfaces with various Sutter research affiliates, administrative staff, Principal Investigators, and clinical trial sponsors when appropriate regarding reimbursement for research services. The incumbent is a member of and reports to the Manager of the Clinical Research Initiation Service (CRIS) which is a function under the Sutter Research Integrate Service and Administration (RISA).
As a new organization – launching in 2015 – RISA's objective is to implement an integrated support function that standardizes the administrative and financial support functions of grants and contracts improving service to the Sutter research community and providing an increased level of research compliance. Sutter's commitment to deliver services in the most effective and efficient way possible is demonstrated by the commitment made by the Sutter Research Institutes to support this service transformation. Integrating the currently decentralized research support services allows Sutter to expand high quality research and innovation programs and create a pathway for system-wide research.
A Bachelor Degree or equivalent combination of education and experience is required for this role.
CPC Certificate is desired.
• Two or more years of experience in clinical research management is necessary.
• Two or more years of experience in human subjects’ protection regulatory analysis is desirable.
• Certification in medical coding is desirable.
• Intermediate/Advanced Excel skills is desireable.
• Medicare benefit categories, statutory exclusions, and national and local coverage determination and of national medical practice guidelines, Food and Drug Administration investigational drug and device research is necessary.
• Medical coding, protocol visit span allowances, protocol-specified clinical services, and basic research study demographics of clinical research financial activities and documentation required before study initiation, including research protocol, internal budget, sponsor contract and budget, and consent template
• Demonstrated budgetary and strategic planning responsibilities and experience.
• Proven ability to work effectively with both technical and non-technical personnel.
• Demonstrated excellence in written, oral, electronic communication and presentation skills; scientific writing skills.
• Ability to use multiple technical systems as intended; ability to collaborate across revenue cycle, compliance, and research operations teams; and attention to detail are necessary.
• Ability to review complex documents and determine sufficiency of financial documentation independently and/or in collaboration with research administrators
• Ability to conduct research independently identify and document evidence of medical necessity and federal billing status of clinical trial protocols is necessary
• Excellent verbal and written communication skills
• Excellent analytical, budgeting and computer skills
• Requires ability to work independently and to accept responsibility for complex and sensitive decision-making as it relates to the position.
• Outstanding organization skills are necessary to manage many competing timetables and responsibilities.
• Ability to multi-task
Primary Location: California, East Bay, Walnut Creek
Organization: Sutter Health System Office
Employee Status: Regular
Position Status: Exempt
Job Shift: Day
Shift Hours: 8 Hour Shift
Days of the Week Scheduled: Monday-Friday
Weekend Requirements: None
Schedule: Full Time
Hrs Per 2wk Pay Period: 80
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.