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Cedars-Sinai Sr Research Medicare Coverage Analyst - Office of Research Administration in Los Angeles, California

Our Senior Research Medicare Coverage Analyst is a professional position working under the general supervision of the Associate Director, Clinical Trials Administration Office to support the institutional goal of compliance in clinical research budgeting and billing. In this exciting but highly important role, you will provide high-level professional support in the growing efforts to conduct prospective Medicare Coverage Analysis for all clinical research studies.

You day to day job duties and responsibilities will include:

  • Screening research protocols to determine whether a formal Medicare Coverage Analysis (MCA) is required.

  • Collaborate with investigators to determine whether each study is a qualifying clinical trial under CMS Clinical Trial policy.

  • Based on CMS policy and National and Local Coverage Determinations, as well as professional practice guidelines, reviews clinical research protocols and determines which procedures are routine, and therefore, billable to Medicare and other third party payers. This often requires extensive independent research to identify applicable practice guidelines. This also requires the incumbent to be cognizant of changes related to the CMS interpretations and implementation of its policies, which have been controversial.

  • Completely and effectively documents MCA determinations to support the decision-making process. This documentation may be subject to inspection by CMS and regulatory agencies.

  • Reviews patient informed consent forms to ensure that the document accurately informs patients which procedures will be billed to their insurance vs. those that will be covered by the study budget, in accordance with the MCA.

  • Provide training and consultation to investigators and research staff and managers on regulations and policies related to Medicare coverage in research. Also provides consultation in the development of investigator-initiated protocols with respect to implications for Medicare billing.

  • Attend IRB meetings to provide education to IRB members and address questions raised regarding the Medicare Coverage Analysis and associated informed consent language. Coordinates with IRB staff and the investigator if the IRB raises issues regarding the determinations of the Medicare Coverage Analysis and/or consent form language.

  • Collaborate and communicate effectively with investigators and research staff, Patient Financial Services, IRB and Chief Compliance Officer with respect to Medicare Coverage Analysis issues and determinations.

  • Assist with the development of institutional policies and procedures pertaining to clinical research budgeting and billing, including the MCA process.

  • Keep current with FDA and Medicare regulations and CA state laws applicable to clinical research billing.

  • Conduct special department related projects as they are assigned.

Experience:

  • Minimum five (5) years experience in clinical research conduct, administration or coordination

Educational Requirements:

  • Bachelor’s Degree in healthcare or science related discipline. Nursing Degree and RN licensure preferred.

  • Minimum five years experience in clinical research conduct, administration or coordination.

  • License/Certification/Registration Requirements: RN preferred

License/Certification/Registration Requirements:

  • RN Preferred

Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.

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