Coverage Analysis Specialist

Key Responsibilities, but not limited to: Reviews the clinical trial to determine if the study meets the qualifying trial criteria set forth in the Medicare clinical trial policy. Conducts an analysis of all procedures performed as part of the clinical research protocol using the Payer coverage rules to determine if the study is a qualified study, and whether the procedures to be performed will be covered by the research sponsor, the subject’s insurance carrier, or the patient themself. Collaborates with the investigator and study team as well as the appropriate coding resources to review any procedures that are not clear from the protocol document. Enters the billing indicator, appropriate qualifiers are document using the Clinical research management System. Ensures billing information is consistent between CRMS and EPIC billing grids. Assist in obtaining necessary approvals for medical device studies. Reviews EPIC research charge reports for accuracy and resolves discrepancies.

Minimum Qualifications:  A Bachelor's Degree in Finance, Business Administration, Healthcare, or related field. 2 years prior experience with research budgets and/or hospital billing processes. Working knowledge of the Medicare clinical trial policy. Must have experience working closely with physicians and/or research study teams. Working knowledge of medical vocabulary and terminology. Knowledge/Understanding of Clinical Research Funding, IRB's, EMR's, etc.

Preferred Qualifications: Coverage Analysis experience. Coding knowledge and experience. 

Competencies:  Action oriented, Functional/technical skills, Interpersonal skills, Organizational skills, Analytical skills, Time management, and Written communications. Respects diversity. 

Working Conditions/Physical Demands: Business Office Setting.  

This position provides a review and analysis of the clinical research study to ensure compliance with Medicare’s clinical trial policy and institutional billing compliance policies.

Essential Functions 

Ability to provide a review and analysis of the clinical research study ensuring compliance with Medicare’s clinical trial as well as institutional billing compliance policies.

Ability to sit or stand for prolonged periods of time. 

Ability to lift up to 25 pounds occasionally. 

The University of Pittsburgh is committed to championing all aspects of diversity, equity, inclusion, and accessibility within our community. This commitment is a fundamental value of the University and is crucial in helping us advance our mission, which includes attracting and retaining diverse workforces. We will continue to create and maintain an environment that allows individuals to discover, belong, contribute, and grow, while honoring the experiences, perspectives, and unique identities of all.

The University of Pittsburgh is an Affirmative Action/Equal Opportunity Employer and values equality of opportunity, human dignity and diversity. EOE, including disability/vets.