Company :

Job Description :

GENERAL OVERVIEW:

Responsible for the Medicare Coverage Analysis (MCA) for sponsored projects within WPAHS, budget development and contract negotiations.

ESSENTIAL RESPONSIBILITIES:

• Responsible for supporting management in the completion and tracking of MCA's. Reviews protocols, informed consent forms, contracts, Notices of Grant Award, FDA letters in the Conduct of an MCA. A key responsibility is the creation, revision and management of spreadsheets related to Medicare coverage analysis and compliance with Medicare rules and regulations. (60%)
• Use MCA analysis to develop study budgets and negotiate contracts with sponsors to ensure maximum reimbursements to AHN. (25%)
• Meet with research teams (Principal Investigators and study coordinators) to review MCA analysis, study budgets and contracts. (5%)
• Coordinate with other service departments to determine appropriate service/cpt codes for use in the MCA billing grid. (5%)
• Work closely with the clinical trial billing team to ensure that MCA is accurate, and make modifications if needed. (5%)
• Performs other duties as assigned or required.

QUALIFICATIONS:

Minimum

• Two years’ experience within a health care or clinical setting
• Advanced experience using spreadsheet and word processing applications
• Knowledge of regulations regarding the protection of human subjects in clinical research
• Knowledge of medical terminology

Preferred

• Bachelor’s degree in Business, Finance or related field or equivalent experience
• Experience as a Research Coordinator, Clinical Coordinator, Clinical Research Associate, Coding Professional or related field

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice