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Clinical Research Senior Billing Reviewer - Office of Clinical Research (CTSI)

Charlotte, NC, United States
Job ID: 108215
Job Family: Research Services
Status: Full Time
Shift: Day
Job Type: Regular
Department Name: 55541005040303-Clinical Trials

Overview

JOB SUMMARY:

The Senior Clinical Research Billing Reviewer is a position that resides in the Office of Clinical Research (OCR). This is a hybrid position that reports to either the Manager, Clinical Research Billing Review or the Manager, Clinical Research Invoicing and Closeout. The position is a high-level position responsible for activities either related to charge capture and claim resolution in Epic (electronic health record and patient billing system) for clinical research studies across all regions of the Atrium Enterprise or invoicing and accounts receivable activities in OnCore (clinical trial management system), ClinCard (electronic participant payment system) or EPIC. The position is responsible for performing assigned activities, which can include but is not limited to line-item charge review of research patient encounters in the Atrium Health charge capture system, EPIC; the generation and send out of invoices to sponsors and Departments; the tracking and monitoring of receivables; and the reconciliation of payments to OnCore, EPIC, ClinCard and CORE Connect (institutional financial system). The position will assure the accuracy and completeness of all assigned work.

ESSENTIAL FUNCTIONS:

Financial Management Supports the study team in the financial management of clinical trials originating from federal, foundation, and industry funds by performing all accounts receivable functions.

Generates and sends invoices to study sponsors.

Tracks and monitors receivables from sponsors, including pass-through fees and milestone payments. Generates reports to project study financials.

Reconciles payments received to OnCore and CORE Connect (Oracle Cloud institutional financial system). Notifies Financial Services of appropriate study account to receive payment.

Resolves any financial issues with sponsor as needed. Ascertain amount paid and remaining amount due on assigned study sponsor accounts; establish payment plan with Department Contact guarantors regarding past due accounts; re-evaluate existing payment plans as needed when account is delinquent.

Follow up with Departments to ensure proper amounts are collected; independently recommend action to be taken regarding the account.

Initiate calls to Departments to ascertain whether the proper amount has been paid on the research account. Mail financial statements to Departments.

Review balances on accounts and communicate with Departments via phone and email to explain professional and hospital billing and collection policy and procedure.

At the completion of the study, supports Department post-award personnel and Sponsored Programs in the review of revenue received prior to close out of the study account.

Supports the closeout of study activities in OnCore, ClinCard and EPIC. EPIC Charge Capture Activities Performs review of all technical and professional charges generated from EPIC and any ancillary subsystems for allocation to the research study account, insurance claim and/or patient statement to verify the accuracy of charges as they compare to the research billing intention/plan outlined in the protocol Billing Grid.

Performs remediation of charge errors discovered during EPIC review. Identifies appropriate use of billing modifiers and other CMS requirements for billing research-related charges to federal and non-federal payors.

Verifies and resolves discrepancies by utilizing the tools and resources available, e.g., EPIC billing system, OnCore (clinical trial management system), medical record documentation, Charge Master data, Patient Accounting/VMG Business Offices and/or contacting study personnel in the appropriate internal department.

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

Collaborates with the clinical research department administrators and study coordinators in the development and implementation of educational activities related to charge capture improvement projects.

Supply all missing information and correct inaccurate data as needed.

Processes charge related corrections/additions/removals in EPIC for both the hospital and physician billing to ensure organizational compliance with all state and federal regulations.

Calculates and facilitates the refunding of inappropriate reimbursement in collaboration with WFBMC Financial Services. Responsible for the movement of funds and correction of fees in EPIC.

Follows established hospital and physician departmental guidelines and state and federal regulations to assure the most productive and compliant outcome when processing charge related corrections.

Perform specialized duties involved in the preparation and processing of particularly complex charge issues.

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

Identify insurance issues that need to be forwarded and addressed by the appropriate insurance teams. Report issues to the appropriate supervisor as needed.

General Support Prioritizes job tasks; demonstrates willingness to assist Manager/Director in the completion of special projects and daily task to support the Department s productivity and efficiency.

Demonstrates responsibility for personal development by participating in continuing education offerings. Performs other related duties incidental to work described herein.

EDUCATION/EXPERIENCE:

Bachelor s degree in a related field or an equivalent combination of education and experience is required. Minimum of 5 years coding/reimbursement experience required for activities related to charge capture. Medical terminology, knowledge of accounts payable and receivable processes required. LICENSURE, CERTIFICATION, and/or REGISTRATION: CPC or RHIT certification required only if assigned activities relate to EPIC charge capture and allocation.

SKILLS/QUALIFICATIONS:

Excellent oral and written communication skills. Excellent phone etiquette and internal/external customer service skills, required. Strong interpersonal skills and attention to detail. Experience with computerized databases (e.g., Microsoft Excel), word processing (e.g., Microsoft Word), and presentation software (e.g., Microsoft PowerPoint). Demonstrates ability to work independently while managing competing priorities/deadlines. WORK ENVIRONMENT: Clean, comfortable, well-lit, office environment.