Senior Medicare Coverage Analyst
Company: Dana-Farber Cancer Institute
Location: Cleveland
Posted on: April 22, 2024
Job Description:
The work location for this position is full remote with
occasional time onsite.The Medicare Coverage Analyst (MCA) is
responsible for reviewing clinical research protocols, Informed
Consent Forms, Clinical Trial Agreements, and other relevant
study-related documents to create a coverage analysis/billing
guide. The coverage analysis indicates which medical
procedures/services maybe 'Routine Cost' and billable to patient
insurance and which should be billed to the study sponsor.The
Medicare Coverage Analyst determines whether proposed clinical
research studies are a Qualifying Clinical Trial as defined by the
Medicare Clinical Trial Policy (NCD 310.1) and designates medical
procedures/services based on relevant regulations and
determinations.The Medicare Coverage Analyst independently executes
coverage analysis activities.Located in Boston and the surrounding
communities, Dana-Farber Cancer Institute is a leader in life
changing breakthroughs in cancer research and patient care. We are
united in our mission of conquering cancer, HIV/AIDS and related
diseases. We strive to create an inclusive, diverse, and equitable
environment where we provide compassionate and comprehensive care
to patients of all backgrounds, and design programs to promote
public health particularly among high-risk and underserved
populations. We conduct groundbreaking research that advances
treatment, we educate tomorrow's physician/researchers, and we work
with amazing partners, including other Harvard Medical
School-affiliated hospitals.
- Creates coverage analysis grids based on clinical trial
protocol documents
- Researches and applies policies, guidance and guidelines from
various sources including federal and state regulations.
- Applies clinical guidelines, Medicare regulations, and study
team guidance of conventional care to independently determine which
services are considered routine care
- Disseminates the completed coverage analysis to key
stakeholders to expedite clinical research start-up - budgets and
negotiation team, internal and external satellite sites, and
department operations leads
- Reviews and assesses protocol amendments for potential
budgetary impact and makes appropriate updates to the coverage
analysis to ensure on-going regulatory compliance
- Serves as the primary point of contact for initiating budgeting
activities between the Clinical Trials Business Office and the
study team/clinical department
- Documents and notates coverage analysis and associated
documentation in clinical trials management system
- Creates disease-focused expertise by updating, retaining
reference documents in institutional coverage analysis library
- Bachelor's Degree or RN Credential required
- 5 years of Medicare coverage analysis experience required
- Experience with research activity in an academic medical
center
- Experience working in clinical trials management system
(CTMS)
- CPT/DRG Coding experience preferred
- Understanding of research activity in an academic medical
centerKNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:
- Understanding of research activity in an academic medical
center
- Knowledge of billing compliance and Medicare
regulations/policy, applicable federal, state, and local laws,
rules, regulations and policies and institutional policies and
standard operating procedures
- Knowledge of clinical research budgeting and the clinical trial
life cycle: study start-up through study closure
- Knowledge of clinical trials management system (CTMS)At
Dana-Farber Cancer Institute, we work every day to create an
innovative, caring, and inclusive environment where every patient,
family, and staff member feels they belong. - As relentless as we
are in our mission to reduce the burden of cancer for all, we are
equally committed to diversifying our faculty and staff. - Cancer
knows no boundaries and when it comes to hiring the most dedicated
and diverse professionals, neither do we. If working in this kind
of organization inspires you, we encourage you to apply.Dana-Farber
Cancer Institute is an equal opportunity employer and affirms the
right of every qualified applicant to receive consideration for
employment without regard to race, color, religion, sex, gender
identity or expression, national origin, sexual orientation,
genetic information, disability, age, ancestry, military service,
protected veteran status, or other characteristics protected by
law.
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Keywords: Dana-Farber Cancer Institute, Euclid , Senior Medicare Coverage Analyst, Professions , Cleveland, Ohio
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