Medicare Coverage Analyst
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 center
KNOWLEDGE, 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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