Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that's served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It's our passion.

Primary Purpose

Responsible for providing a detailed review of clinical trial billing processes to ensure that related services and items rendered to patients are billed to the appropriate payer as designated by the Budget Grid and Coverage Analysis. This includes ensuring all clinical trial services and items conducted for research purposes only are billed to the Research Sponsor and not to any third-party payer.

Minimum Specifications

Hybrid 3 days in office M,W,Th (first 90 days onsite).

Education

• Must have a bachelor's degree in a clinical field, healthcare administration, business administration, or related field.

Experience

• Must have 2 years progressively responsible experience in a healthcare related field, administrative, financial, legal audit, or compliance role, preferably in a hospital setting.
• Must have 2-year experience dealing with Medicare and Medicaid compliance and reimbursement issues including providing customers with meaningful assistance at remedying compliance issues.
• Must have 1 year working knowledge clinical trials and accounting principles.
• Medical terminology knowledge required.

Equivalent Education and/or Experience

• May have an equivalent combination of education and/or experience in lieu of specific education and/or experience as stated above.

Certification/Registration/Licensure

• Professional certification in Professional Coding (CPC-H), preferred.

Skills or Special Abilities

• Demonstrated ability with planning and executing Medicare and Medicaid billing compliance reviews in a wide range of clinical settings with only general supervision.
• Ability to read, comprehend and extract pertinent medical record information.
• Ability to read and comprehend a budget grid (schedule of study activities), clinical trial coverage analysis (CTCA) and study protocol.
• Excellent verbal and written communication skills.
• Ability to communicate effectively with all levels of personnel and demonstrate tact and diplomacy skills.
• Strong orientation to deadlines and details with the ability to meet competing deadlines.
• Demonstrated competency in planning and implementing technical training.
• Strong organizational and planning skills.
• Ability to manage competing demands.
• Consistent and successful follow through on issues and problems.
• Computer literate and proficient with MS Office applications.

Responsibilities

1. Monitors work queues to identify charge posting for patients on clinical trials.
2. Reviews protocol with related amendments, budget grid, accrual list, and medical record documentation against patient bill and remove research charges.
3. Removes bill holds once research charges removed.
4. Ensures proper Medicare coding is applied.
5. Assists with creating budget grids and coverage analysis.
6. Prepare documents for Clinical Trial Feasibility Committee.
7. Analyzes error reports and work queues and research billing, coding, reports and systems requirements for potential solutions. Ensures successful resolution of identified charge posting problems.
8. Identifies process issues that impact the accuracy of charge posting that originates from the functional areas. Works with department staff to correct individual charges posted and provides feedback to avoid similar errors on future claims.
9. Enters data into existing systems and participates in the development of new data systems and tools for electronic clinical trial finance/document administration.
10. Assists with developing education and training to clinical and front-end staff related to charging requirements for the functional area. Assists with developing re-education to department staff based on results of reviews to correct potential weaknesses and ensures ongoing compliance.
11. Assists with special projects such as annual charge code updates or external chargemaster review and pricing analysis.
12. Works collaboratively with Parkland and UTSW departments to identify solutions to process problems.

Job Accountabilities

1. Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.
2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
3. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.As part of our commitment to our patients and employees' wellness, Parkland Health is a tobacco and smoke-free campus.