1. Utilize and review study specific Medicare Qualifying determinations (MQT) as well as the billing grids in OnCore. 2. Perform comprehensive and independent review of all documents related to research study funding, including the research study budget, protocol, contract, informed consent, and other supporting core documents. 3. Analyze, interpret, and apply Medicare Coverage rules; identify services as non-covered research-only care, usual routine care, expanded care and investigational items and services; advise investigators and study staff on applicable regulatory requirements. 4. Analyze, interpret, and apply internal and external research billing policies, assisting faculty, study staff, and clinical managers in determining applicable review requirements and facilitating timely budget approval 5. Provide excellent customer service and accurate guidance to clinical research budget analysts regarding clinical research budgeting and billing policies and procedures. 6. Work collaboratively with financial management staff, and the research compliance staff to ensure the accuracy of data entered in the billing compliance risk assessment as well as the financial console in OnCore, to ensure accuracy.
Preferred Education: CPT, HCPCS, and ICD-10 working experience. Relevant coding certification. Coverage Analysis Certification and/or confirmation of formal training. Current Procedural Coding Certification (AAPC). Experience working in OnCore system as it relates to clinical research billing compliance/ finance. Working knowledge of the full range of pre-award activities related to clinical trial research.
Preferred Education, Experience and Skills: CPT, HCPCS, and ICD-10 working experience. Relevant coding certification. Coverage Analysis Certification and/or confirmation of formal training. Current Procedural Coding Certification (AAPC). Experience working in OnCore system as it relates to clinical research billing compliance/ finance. Working knowledge of the full range of pre-award activities related to clinical trial research.
Required Skill/ability 5: Maintain excellent punctuality and attendance, and remain an outstanding professional, collaborative, and customer service-oriented representative.
Posting Position Title: Coverage Analyst, YCCI
Required Skill/ability 3: Ability to follow instructions, meet expected turnaround times, monitor, analyze, and improve processes in a time-sensitive environment.
Work Week: Standard (M-F equal number of hours per day)
University Job Title: Coverage Analyst
Required Skill/ability 1: Strong working knowledge of medical terminology. Proven experience collaboratively with faculty, administrators, and staff in an academic medical center, health care or university environment.
Required Skill/ability 4: Excellent written and verbal communications skills. Strong organizational skills and attention to detail are a must. Excellent analytical, problem-solving and decision-making skills. Ability to learn and utilize other software and healthcare technology related systems, and web-based tools.
Required Skill/ability 2: Proven ability to communicate positively and effectively in all situations, professionally participate in discussions regarding the Yale clinical research process.
Bachelor's Degree and four years of related experience or equivalent combination of education and experience.
Internal Number: 61936BR
About Yale University
Yale University is an American private Ivy League research university located in New Haven, Connecticut. Founded in 1701 in the Colony of Connecticut, the university is the third-oldest institution of higher education in the United States.