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Providence Health & Services Coverage Analyst PSJH *Telecommute* in Nevada

Description:

Providence St. Joseph Health is calling a Coverage Analyst PSJH to work remotely within our footprint states: AK, CA, MT, NV, OR, TX and/or WA.

We are seeking a Coverage Analyst PSJH who will support the clinical research programs across the Providence Health System by developing a Medicare Coverage Analysis for all clinical trial protocols that include billable services. This position reports to the Coverage Analysis Manager and includes collaboration with several research entities within Providence. Main responsibilities include completing a comprehensive Medicare Coverage Analysis in alignment with Medicare's Clinical Trial Policy, national medical guidelines, local practice guidelines, peer-reviewed publications and local and national coverage determinations that encompasses all billable services within the clinical trial protocol. Partner with CTMS, Budget, and Billing Adjudication teams to ensure compliance with federal regulations and internal policies. Must uphold the standards of confidentiality, attendance and punctuality. Performs all duties in a manner that promotes team concept.

In this position you will have the following responsibilities:

  • Review the clinical trial protocol to assess if it is a qualifying clinical trial per Medicare's Clinical Trial Policy.

  • Complete a comprehensive review of the clinical trial protocol, informed consent, budget, contract and any other study documents.

  • Analyze, interpret and apply the Medicare Coverage rules and internal and external billing policies to determine which services indicated in the clinical trial protocol are billable charges and which should be deemed as non-covered research only services.

  • Summarize and document the justifications being used to make the determination for a service being deemed as a billable charge. This may include national or local coverage determinations, national medical guidelines, peer-reviewed publications or local practice guidelines.

  • Collaborate with Office of Research Administration Budget staff to facilitate the budget negotiation process and review final study documents for accuracy.

  • Participate in ongoing professional development opportunities as appropriate.

  • Cultivate and maintain positive working relationships with internal stakeholders as well as external sponsoring agencies.

  • Has access to and maintains confidentiality of sensitive financial records, and Patient Health Information.

  • Prepare and delivers informal training and instruction on Sponsored Project processes as necessary to the greater Providence organization.

  • Provide quality assurance review of colleagues' coverage analysis documents.

  • Assist in drafting revisions and updates to organizational policies and procedures pertaining to Coverage Analysis and Medicare compliant billing in conjunction with federal laws, rules, and regulations.

  • Participate and/or assists in special projects, and performs associated administrative duties, as assigned; may provide functional direction to lower level staff on assigned work.

Qualifications:

Required qualifications for this position include:

  • Bachelor's Degree in Healthcare Administration or related field -OR- 4 years additional related experience.

  • 3 years Direct experience in Coverage Analysis development and interpretation of Medicare requirements for research.

Preferred qualifications for this position include:

  • 4 years Experience in research, billing, or healthcare administration.

About the department you will serve.

Providence Shared Services provides a variety of functional and system support services for our Providence family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit

https://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Research

Location: Texas-Lubbock

Other Location(s): Montana, Nevada, California, Oregon, Washington, Texas, Alaska

Req ID: 320659

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