Washington University is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity or expression, national origin, genetic information, disability, or protected veteran status.
This position is full-time and works approximately 40 hours per week.
Department Name/Job Location:
This position is in the Department of Center for Clinical Studies. This position is for the Medical School Campus.
Position is responsible for performing Prospective Reimbursement Analysis to ensure that clinical services associated with clinical research studies are billed in compliance with the CMS National Coverage Decision and all other applicable laws and regulations, third party requirements, and Washington University School of Medicine (WUSM) policy. Participate in clinical research billing compliance related projects, analyze report data to identify problems associated with the patient billing and collection process, and propose solutions. Summarize and report on findings. The Clinical Research Billing Analyst will also provide assistance and function as a resource and educator to other staff in developing and/or negotiating clinical study budgets, informed consents and contracts.
PRIMARY DUTIES AND RESPONSIBILITIES:
Perform Prospective Reimbursement Analysis by:
Review clinical study protocol, budget, consent form, and IRB applications to determine whether or not a particular item or service is Standard of Care or Investigational
Determine CPT and ICD 9 CM codes, when necessary & appropriate, for procedures performed as part of the clinical study
Determine whether services provided as part of the clinical study should be billed to third party payers or the clinical study fund
Prepare and submit requests for Medicare coverage determinations as needed
Perform clinical study protocol set-up for correct identification of services and schedules in a clinical research billing compliance system
Maintain a close working relationship with clinical research billing compliance staff at affiliated hospital(s), university grant administrators, departmental clinical research staff, IRB members and staff, and compliance officers.
Continue to build a working relationship with BJH/C personnel and to develop mutually agreeable process to enhance clinical trial billing compliance and optimize account management for patients enrolled in clinical research studies. Assess nature and scope of clinical research study billing or reimbursement problems, investigate cause and report on findings. Provide recommendations on improvements to workflow, systems or any other process. Identify system functionality enhancements required to streamline data capture, billing and collections.
Provide guidance to PI’s, study coordinators, department administrators, and other parties on topics related to professional and/or technical billing in the context of clinical research.
Assist departments in determining the per subject portion of their budgets for sponsored research projects and industry clinical trials.
Coordinates with assigned clinical department’s/division’s compliance liaison(s) to facilitate compliance at the departmental/divisional level.
Respond to inquiries regarding coding, documentation, and billing compliance issues.
Maintain a current knowledge of laws and regulations governing professional fee billing and inform clinical departments, faculty, and staff of changes in federal regulations or University policy related to research and billing compliance.
Assist/perform special audits and/or other projects as assigned.
Bachelor’s degree or equivalent.
Experience in health care related field required.
Registered Health Information Administrator (RHIA) and/or Registered Health Information Technician (RHIT), CPC, or CCS-P certification required.
3 years experience in medical billing, coding, or clinical trials
Thorough knowledge of government billing regulations, medical insurance billing procedures, and medical terminology
Experience in clinical research coordination
Experience in medical record review, knowledge of ICD-9 and CPT coding
Excellent interpersonal and communication skills
Ability to prioritize multiple demands
Team-oriented and results-driven person
Basic Microsoft Excel skills
Intermediate Microsoft Word skills
Applicant Special Instructions:
Normal office environment, local travel to the medical school/hospitals and physician’s offices.
The hiring range for this position is $65,624 - $83,678 annually.
-Retirement Savings Plan -22 vacation days -8 Paid Holidays -Sick Time -Tuition benefits for employee, spouse and dependent children -Free Metro Link/ Bus pass -Free Life Insurance -Health, Dental, Vision -Health Savings Accounts (HSA) -Long Term Disability Insurance -Flex Spending Plan -Other Benefits
Med School HR website (medschoolhr.wustl.edu)
Internal Applicant Instruction:
This position is grade C14.
Please attach a copy of your most current signed performance evaluation (completed within the last 18 months) to your online account. If you have not received a performance evaluation, you may provide two current signed letters of recommendation (written within the last 18 months), preferably to include one letter from either a current or recent former supervisor. To attach these documents, go to: My Career Tools, Add Attachment, Attachment Type – Performance Reviews or Letters of Recommendation.
Washington University in St. Louis, a medium-sized, independent university, is dedicated to challenging its faculty and students alike to seek new knowledge and greater understanding of an ever-changing, multicultural world. The University offers more than 90 programs and almost 1,500 courses leading to bachelor's, master's and doctoral degrees in a broad spectrum of traditional and interdisciplin...ary fields, with additional opportunities for minor concentrations and individualized programs. The faculty is composed of scholars, scientists, artists and members of the learned professions. They serve society by teaching; by adding to the store of human art, creativity, understanding, and wisdom; and by providing direct services, such as health care.