The Coverage Analyst is responsible for reviewing clinical research trial protocols to determine if they are qualified clinical trials pursuant to Medicare’s Clinical Trials Policy (NCD 310.1). This individual evaluates research billing through conducting Coverage Analysis (CA) which ensures consistent application of National, Local Coverage determination, and National Comprehensive Cancer Network guidelines. The analyst identifies appropriate research modifiers using the Centers of Medicare and Medicaid Services (CMS) guidelines. This individual also synchronizes the clinical trial protocol, budget, contract, and informed consent to ensure that they are all consistent when it comes to billable items and language that concerns patient billing.
- Bachelor’s degree or equivalent.
- Minimum one (1) year of coverage analysis experience.
- Strategic thinking and creative problem solving. Must be self-aware and curious, committed to diversity, equity and inclusion.
- Must be ambitious and able to work collaboratively. A successful candidate will be detail oriented with the ability to communicate with and build relationships.
- Must be flexible, able to manage short deadlines & multiple priorities.
- Must be able to demonstrate good judgment in decision-making and the ability to maintain strict confidentiality.
- Demonstrated ability to follow written and oral instructions.
- Demonstrated sense of urgency.