Job Description: Oregon Health & Science University
Oregon Health & Science University values a diverse and culturally competent workforce. We are proud of our commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status. Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation contact the Affirmative Action and Equal Opportunity Department at 503-494-5148 or aaeo@ohsu.edu.
Senior Coverage Analyst
US-OR-Portland
Job ID: 2024-31897 Type: Regular Full-Time # of Openings: 1 Category: Administrative/Office Support Portland, OR (Marquam Hill)
Overview
Independent review, analysis, support: Using professional expertise and sound judgment, as well as analytical, organizational, and time management skills, perform independent, accurate and timely review and analysis of research billing inquiries to resolve, provide guidance, and collaborate with other staff for resolution. Appy advanced knowledge of federal, state, local, and OHSU statutes, regulations, guidance, and policies and procedures, as well as relevant technology to:
Provide advanced professional coverage analysis and serve as main resource for other staff and the OHSU research community
Respond to any inquiries pertaining to the Coverage Analysis process
Address incoming inquiries to resolve and/or delegate to other team members
Lead the determination of whether proposed clinical research studies are a qualifying clinical trial (QCT) as defined by the Medicare Clinical Trial Policy (NCD 310.1); designate medical procedures/services based on relevant regulations and determinations.
Effectively communicate results to study teams to ensure consensus regarding research costs vs. routine costs.
Maintain a comprehensive database (Smartsheet) of all Coverage Analysis request submissions to track overall progress of each review.
Serve as an expert institutional resource related to Medicare billing rules and a functional expert on the internal process supporting compliant clinical research billing.
Provide ongoing education related to CRBO Coverage Analysis Policy to the OHSU research community
Assist management and leadership to improve processes within and across clinical research by collaborating on the development of policies, procedures and recommendations to leadership.
Training, communication, and advisory services*:
Work with CRBO manager to develop and implement education and communication outreach activities that will provide and document accurate and continuous research billing education programs for the OHSU community.
Collaborate with CRBO manager to develop and implement internal clinical research billing compliance education activities to continuously improve research billing compliance and related areas.
Policies and procedures*:
Identify deficiencies and advise on how to achieve compliance with regulatory requirements in an efficient manner.
Lead ongoing assessment of the Coverage Analysis process with a goal of streamlining and improving overall flow; implement new and/or maintain existing policies and procedural changes.
Continuous Quality Improvement*:
Lead the continuous quality improvement initiatives for the Coverage Analysis process in partnership with the CRBO manager.
Identify weaknesses and deficiencies and provide input to CRBO manager on how to enhance the quality and efficiency of the work performed.
Technology liaison*:
Collaborate with Epic Research Revenue Cycle and CTMS Support to provide input, evaluate and test clinical research billing functionality in Epic and the CTMS.
Other duties as assigned*:
Other special projects, as determined by CRBO manager.
Responsibilities
Bachelor’s degree in related field.
7 years of relevant experience in clinical research, billing compliance, or related.
Ability to effectively work both independently and in a team environment.
Effective organizational abilities, oral and written communication skills, and interpersonal skills.
Ability to operate and communicate effectively while meeting multiple deadlines and completing projects simultaneously.
Ability to interact in a positive, productive manner with researchers, staff and leadership (demonstrating sensitivity, tact, and professionalism).
