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Northwell Health · 1 day ago

Clinical Research Specialist

1111 Marcus Ave, Lake Success, NY, 11042, US

Full-time

Onsite

Entry Level

1+ years exp

Northwell Health is a leading healthcare provider, and they are seeking a Clinical Research Specialist to support clinical research billing compliance and manage accounts for clinical trials. The role involves ensuring accurate billing for clinical research protocol visits, coordinating with payers, and resolving billing discrepancies.

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Responsibilities

Follows all clinical trial subject accounts to assure timely review, processing, payment, and accurate reimbursement

Performs detailed analysis of clinical trial accounts and agreements using multiple resources and systems including EPIC for decision making of whether charges are billable to insurance or billable to the study

Responsible for the contacting third-party payers to verify timely billing requirements. Add and update clinical trial information on patient accounts

Effectively utilizes reports, and special projects to resolve claim rejections on accounts as well as identify problem accounts. Identifies and takes action needed to resolve accounts. Resolves problem accounts using all available resources, both internally and externally, as evidenced by observation, documentation, and feedback. Respects confidentiality of patient information and uses discretion when answering questions

Assists in performing routine billing functions/job duties accurately and efficiently. Assists in processing all inpatient, outpatient and reoccurring accounts for all payers and all facilities, in an accurate, compliant, and timely manner by investigating billing errors

Performs remediation of charge errors discovered during review EPIC review

Determines and adds appropriate billing modifiers and other CMS (Centers for Medicare & Medicaid Services) requirements for billing research-related charges to subjects insurance

Knowledgeable about CMS and Fiscal Intermediary medical necessity guidelines and their impact on billing and reimbursement in clinical research

Audit and review accounts to ensure accuracy; investigate and correct errors, follow-up on missing account information, and resolve past due accounts

Works with clinical research, coding, billing, compliance, and other internal or potentially external professionals to reconcile any discrepancies in data entered in the system

Prepares statements and invoices based on services rendered every month; maintains accounts receivable by processing sponsor payments, site payments and accounts payable reports; invoice matching, data entry and reconciliation of accounts

Posts payments and check deposits

The Clinical Research Representative ensures that all charges for facility and professional fees arising from clinical research protocol visits and services are consistently segregated and billed to the appropriate payer and/or sponsor, submitted with proper codes, IDE# if applicable, modifiers and NCT number, and properly reimbursed, avoiding efforts in managing denials and mitigating risks of double-billing to both a study sponsor and an insurer

Reviews research informed consent to understand the charges to patients, the Medicare coverage analysis, the billing grid, and the National Coverage Decision (NCD) for clinical trials

Performs related duties as required

Qualification

EPIC research billingClinical trial managementBilling complianceAccounts receivable managementBachelor's Degree

Required

Bachelor's Degree required, or equivalent combination of education and related experience

1-3 years of relevant experience, required

Preferred

EPIC research billing experience, strongly preferred

Company

Northwell Health

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Northwell Health is New York State’s largest health care provider and private employer, with 28 hospitals, about 1,000+ outpatient facilities and more than 16,000 affiliated physicians.

Founded in 1997

Manhasset, New York, USA

10001+ employees