Clinical Trial Reimbursement Specialist

BJC HealthCare is seeking a Clinical Trial Reimbursement Specialist. This remote role will review clinical trial documents to ensure billing compliance according to Medicare billing rules and the legal documents. 

Great opportunity for a BSN candidate who is looking to use nursing experience in a new way! 

Monday-Friday position with ideal candidates living in the Greater St. Louis area. 

BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. With net revenues of $6.3 billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 14 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.

BJC is the largest provider of charity care, unreimbursed care and community benefits in the state of Missouri. BJC and its hospitals and health service organizations provide $785.9 million annually in community benefit. That includes $410.6 million in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In addition, BJC provides additional community benefits through commitments to research, emergency preparedness, regional health care safety net services, health literacy, community outreach and community health programs and regional economic development.

BJC’s patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes-Jewish Hospital and St. Louis Children’s Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country.

Role Purpose

Review the protocol, informed consent, fully executed contract with budget to support the coverage analysis development per the master agreement and Medicare guidelines. These documents will be used to identify procedures required by the documents creating a billing matrix and assigning financial responsibility to the study or patient insurance. The billing matrix will be developed capturing all of the study services and timeframes including information from study documents to support billing compliance. Billing matrix will be provided to revenue management to split the claims to study and/or patient insurance. Applies defined policies and procedures to categorize or analyze departmental issues.

Responsibilities

• Use critical thinking skills and demonstrates comprehensive understanding of research regulations/policies in administering processes to ensure clinical trial billing matrix; ensures compliance with regulatory requirements related to research billing, ensures compliance with the MOU/research agreements, validates completed information to ensure correct coding and billing for services and timeframes for each enrollee in the trials.
• Perform detailed reviews of protocols, fully executed contracts with budgets, informed consent documents, and other supporting information to conduct comprehensive coverage analysis documenting final recommendations for billing.
• Analyze routine research billing compliance audits of research accounts to ensure billing compliance per study documents. Respond to questions from revenue management timely including review of charges and billing matrix including working and confirming with study team that research accounts and patient insurance are being billed appropriately. Notify revenue management of any errors in billing matrix to review all subjects at risk.
• Understands the clinical trial pricing strategy to provide research teams information to prepare budgets and/or explain annual rate structures. Liaison to BJC entities to ensure clinical trials and enrollees are identified for trials not supported by billing matrix.
• Maintain organizational workflow process to build billing matrix based on department priority working closely with research teams and liaisons. Meet weekly productivity measurement expectations are met to ensure timely and accurate filing of claims.

Minimum Requirements

Education

• Bachelor's Degree

- HIM/Nursing/related

Experience

• 2-5 years

Supervisor Experience

• No Experience

Licenses & Certifications

• RN or RHIA

BJC Total Rewards

At BJC we’re committed to providing you and your family with benefits and resources to help you manage your physical, emotional, social and financial well-being.

• Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date
• Disability insurance* paid for by BJC
• Pension Plan*/403(b) Plan funded by BJC
• 401(k) plan with BJC match
• Tuition Assistance available on first day
• BJC Institute for Learning and Development
• Health Care and Dependent Care Flexible Spending Accounts
• Paid Time Off benefit combines vacation, sick days, holidays and personal time
• Adoption assistance

To learn more, go to www.bjctotalrewards.com/Benefits

*Not all benefits apply to all jobs

The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job. Equal Opportunity Employer

Salary : $786