The Research Finance and Compliance Specialist will assist St. Luke's and affiliated providers with billing coverage analysis, development and identification of billable versus non-billable tests/procedures in accordance with The Centers for Medicare & Medicaid Services national coverage determination, local standard of care, and National Comprehensive Cancer Network guidelines.
JOB DUTIES AND RESPONSIBILITIES:
Set up new clinical trials accounts, and work as a liaison to clinical trials management, SLUHN Finance, and SLUHN Accounting
Administers pre and post award activities for approximately 150-200+ clinical trial contracts
Assist in the pre-award process by preparing Billing Coverage Analyses (BCAs) and for both industry and grant funded studies, collaborating with study PIs prior to budget implementation to confirm the analyses follow local standard of care, conventional care, and Medicare billing guidelines.
Prepare cost analyses to for NCTN group studies, observational studies, and other unfunded studies to determine profit or loss.
Identify appropriate Current Procedural Terminology (CPT) and Healthcare Common Procedure Codes (HCPCs) along with the appropriate research rate(s) for procedures outlined in each protocol study schedule.
Prepare budget spreadsheet, budget proposals, and other support documents for new clinical trials for review with Research Finance Manager.
Effectively and independently negotiate clinical trial budgets with study sponsors to ensure all costs are identified and covered.
Develop standards & templates for consistency in budgeting and billing across all clinical studies.
Reconcile funds and identify and resolve discrepancies while retaining all necessary back up documentation.
Keep clinical trials management abreast of departmental inquiries, problems, as well as billing, and invoicing issues.
Perform daily and monthly billing compliance reviews on both hospital and professional charges to ensure compliance with billing guidelines and regulations.
PHYSICAL AND SENSORY REQUIREMENTS:
Requires sitting for up to seven hours per day, 4 hours at a time. Standing for up to 4 hour per day 3 hours at a time. Requires frequent fingering, handling and twisting and turning. Occasionally requires lifting, carrying and pushing and pulling objects weighing up to 20 pounds. Occasionally requires reaching above shoulder level. Must have the ability to hear as it relates to normal conversation, seeing as it relates to general vision.
EDUCATION:
Master’s degree (MBA preferred) with research-related certification (e.g. SoCRA, ACRP, CHRC, etc.) and/or more than 3 years directly related experience. Will accept a Bachelor degree with research-related certification (e.g. SoCRA, ACRP, CHRC, etc.) and/or more than 5 years directly related experience. Directly related experience must include experience in industry and government grants administration.
TRAINING AND EXPERIENCE:
Three or more years of directly related experience in an academic or community medical setting, which must include experience in industry and government grants administration. Experience with NIH policies and sponsored research regulations including The Centers for Medicare & Medicaid Services national coverage determination (NCD), and A-133, A-21 and A-110 highly preferred. Organized and detail oriented, with clear demonstration of leadership skills also highly preferred. In-depth knowledge of Microsoft Office Programs (Word, Excel, PowerPoint, Outlook; Internet Functions) required.
Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!