Coverage Analyst

At Houston Methodist, the Coverage Analyst position is responsible for reviewing clinical research protocols, informed consent forms, clinical trial agreements, and other relevant study-related documents. The position determines whether proposed clinical research studies are a qualifying clinical trial as defined by the Medicare Clinical Trial Policy (NCD 310.1), while also being cognizant of Medicare/Medicaid Benefit Policies, third-party Medical Benefit Policies, relevant National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), Code of Federal Regulations (CFRs), state laws, professional practice guidelines, and claims denial report, and when necessary, will consult with the Medicare Administrative Contractor (MAC) for the region. The position will assist with creating a billing justification plan or 'coverage analyses' to reflect which medical procedures and services may be 'Routine Cost' and billable to patient insurance and which ones are research and paid by the study sponsor. This position will develop coverage analysis or billing risk analysis on investigator-initiated, industry-sponsored, and non-industry sponsored clinical trials across multiple disciplines and clinical conditions. The Sr Coverage Analyst position collaborates with Principal Investigators (PI's), Central Business Office (CBO), project managers, study coordinators, investigational pharmacists, and other research and administrative staff to further develop coverage analysis billing plans and confirm current procedural codes (CPT) and Healthcare Common Procedure Coding System (HCPCS) and non-coded services (e.g., study team effort and supplies. This position integrates diverse elements of clinical trial management and requires creativity, teamwork, and collegiality to develop and maintain sound fiscal and administrative systems. The Sr Coverage Analyst position ensures institutional research billing compliance with all applicable federal, state, and local laws, rules, regulations and policies and institutional policies and standard operating procedures.

Requirements:

Qualifications:

LICENSES AND CERTIFICATIONS - REQUIRED

• N/A

LICENSES AND CERTIFICATIONS - PREFERRED

• CCS-P - Certified Coding Specialist Physician-based (AHIMA) OR
• Certified International Credit Professional (CICP) OR
• CPC - Certified Professional Coder (AAPC) OR
• RHIA - Registered Health Information Administrator (AHIMA) OR
• CCRP - Certified Clinical Research Professional (SOCRA) OR
• CHRC - Certified in Healthcare Research Compliance (HCCA) OR
• RN - Registered Nurse - Texas State Licensure and/or Compact State Licensure within 60 days OR
• RN-Temp - Registered Nurse - Temporary State Licensure within 60 days

KNOWLEDGE, SKILLS, AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations

• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security

• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles

• Working knowledge of clinical research billing, third party billing regulations with emphasis on CMS/Medicare rules

• Effective decision-making and team-building skills

• Demonstrates effective oral and written communication skills, including the ability to maintain positive rapport with personnel at all levels and in all situations

• Ability to work under pressure and balance many competing priorities

• Ability to collaborate with difficult people and in demanding situations

• Ability to adapt to a rapidly changing environment and to adjust to new requirements

• Applies sound judgment in applying and interpreting policies, procedures, laws, rules, and regulations applying to compliance and monitoring

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform No
• Scrubs No
• Business professional Yes
• Other (department approved) No

ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.

• On Call* No

TRAVEL**
**Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area Yes
• May require travel outside Houston Metropolitan area No

Company Profile:

Houston Methodist Academic Institute oversees the Education Institute and Research Institute, including 772 faculty and 56,250 learners. The Academic Institute aligns our research and education initiatives in service to the clinical mission, providing solutions that answer the call for new technologies and skills our clinicians need for patient care.

Houston Methodist Education Institute coordinates our primary academic affiliation with Weill Cornell Medicine and other joint programs, including the Engineering Medicine Program at Texas A&M University Intercollegiate School of Engineering Medicine. The Education Institute also oversees continuing medical education and graduate medical education, and supports more than 1,000 trainees in residence for medical, nursing, allied health and research education programs.

Houston Methodist Research Institute supports research programs and infrastructure that enable faculty across the system to bring new scientific discoveries to patients as rapidly as possible through the full cycle of a cure from conceptual bench research, to prototyping and development, to clinical trials and FDA approval. The Research Institute supports more than 1,387 clinical research protocols and $70.3 million in extramurally funded translational research programs.

Equal Employment Opportunity

Houston Methodist is an Equal Opportunity Employer.

Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor – priority referral Protected Veterans requested.