Clinical Trials Billing Auditor

Company: Trinity Health Corporation
Location: Ann Arbor
Posted on: June 8, 2021

Job Description:

Employment Type:

Full time

Shift:

Day Shift

Description:

POSITION PURPOSE

The Clinical Trials Billing Auditor position will focus on reviewing/auditing billing processes within Together Care (Epic) in the conduct of clinical trials being executed within the hospitals in the Michigan Region. The Michigan Region includes the hospital members of South East Michigan and the Mercy Health Region and other Trinity Health hospital locations where regulatory oversight is supplied by Michigan.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

Reviews the accuracy and completeness of clinical trial billing grids (Medicare coverage analyses) that document where charges will be captured for insurance, sponsor and patient billing of inpatient and outpatient hospital services for research participants. Reviews congruence between clinical trial budgets, clinical trial agreements, research protocols/consents, and predetermined coverage analysis to ensure that all aspects of clinical trial billing are aligned with Trinity-Health polices and CMS guidelines and regulations. Responsible for the development of billing policies and procedures, establishing an audit program, providing detailed reports to leadership, that includes not only monitoring of key performance indicators, assuring the accuracy and completeness of research billing plan approval process but also provides training and education to research colleagues. Conducts routine audits and monitoring from a diverse pool of clinical trials conducted by researchers responsible for the execution and conduct of prospective clinical trials where treatments and billing for services is indicated as a qualified clinical trial as defined by CMS. In addition, the audits will include reviews of clinical documentation supporting National Coverage Determination routine costs and coding of insurance claims to mitigate any associated risk with billing efforts. Upholds and interprets the requirements of The Centers for Medicare & Medicaid Services (CMS) billing rules and applicability to Clinical trials. Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participate in their resolution. Maintains the confidentiality of information acquired pertaining to patient, physicians, colleagues, and visitors to our Regional Health Ministries. Discusses patient and hospital information only among appropriate personnel in appropriately private places. Behaves in accordance with the Code of Conduct, Service Excellence Standards, and the Mission, Vision and Values of SJMH. Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.

OTHER FUNCTIONS AND RESPONSIBILITIES

Performs other duties as assigned.

REQUIRED EDUCATION, EXPERIENCE AND CERTIFICATION/LICENSURE

Education: Bachelor's degree in Clinical Research Administration, Healthcare Administration, Nursing, Health Information Management or other related science concentration area preferred.

Experience: Minimum of 5 years of relevant clinical research experience in a hospital setting with knowledge of clinical trial budget preparations and how this relates to Medicare coverage analyses in research. The candidate will need to have the experience and education necessary to intimately understand the conduct of clinical trials in a hospital setting and have the necessary knowledge to promote billing compliance.

Certification/Licensure: Certification in Healthcare Research Compliance (CHRC) may be useful but not required.

REQUIRED SKILLS AND ABILITIES

Requires expert knowledge of regulations regarding billing in the context of research

Medicare Coverage Related to Investigational Device Exemption (IDE) Studies.

Clinical Trial Policy: National Coverage Determination (NCD) for Routine Costs in Clinical Trials (310.1).

Coverage with evidence development (CED): Centers for Medicare & Medicaid Services (CMS), as part of the national coverage determination (NCD), which may determine coverage of an item or service only in the context of a clinical study, which typically also involves a registry.

Understanding of rules that must be followed to prevent triggering the False Claims Act and other fraud and abuse laws arising from noncompliance. Demonstrate positive and strong project managment abilities. Intimate working knowledge of clinical trial/research billing practices and regulations. Must understand and have working knowledge upholding clinical research regulations including human subject protections. Demonstrated verbal and written communication skills including proper written grammar. Postive customer service oriented attitude and behavior as a cooperative member of a team to help refine processes. Working knowledge of Epic desired but not required.

This document is intended to describe the generalized duties and responsibilities, the specialized job functions, and the essential requirements of this job. It is not intended to be an exhaustive statement of all supplemental duties, responsibilities, or non-essential requirements or reflect any accommodations made under the American's with Disability Act, the Michigan Handicapper's Act, or SJMHS's Return to Work Program.

Trinity Health's Commitment to Diversity and Inclusion

Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.

Keywords: Trinity Health Corporation, Ann Arbor , Clinical Trials Billing Auditor, Other , Ann Arbor, Michigan