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.
Your 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.
Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scientists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opportunities for translational and clinical research... and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major teaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.