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Coverage Determination Advisor

2 months ago

Tampa, United States Moffitt Cancer Center Full time
Req#: 81221

Position Highlight:The Coverage Determination Advisor is responsible for advising on and auditing the development of Coverage Analysis for clinical trials, ensuring adherence to timeliness and quality standards.

This role involves conducting independent assessments and providing guidance on whether clinical research trials qualify under Medicare's Clinical Trials Policy (NCD 310.1). Rather than performing coverage analyses directly, the Advisor will review and evaluate these analyses to ensure they meet necessary standards and align with institutional policies.

Key Responsibilities:
Auditing Coverage Analysis:
  • Conduct thorough audits of Coverage Analysis to verify that clinical trials meet the criteria set forth by Medicare's Clinical Trials Policy.
Advisory Role:
  • Provide expert advice on the development and accuracy of coverage analyses, ensuring alignment with Medicare guidelines and identifying services that are eligible for Medicare billing.
Document Review:
  • Review related documents, including contracts, informed consent forms (ICFs), and budgets, to ensure consistency, compliance, and adherence to regulatory requirements.
Compliance Guidance:
  • Offer expert guidance on compliance with institutional policies, as well as federal and state regulations, ensuring quality requirements established by leadership are met.
Recommendations for Improvement:
  • Proactively identify areas for improvement and make recommendations for adjustments to maintain high standards of quality and productivity, all while working with minimal supervision.
  • The Coverage Determination Advisor plays a critical role in ensuring that clinical trials are compliant and aligned with Medicare policies, thereby contributing to the overall success and integrity of the research initiatives.

Credentials and Qualifications:
  • Bachelor's degree in Business Administration, Finance, Healthcare, RN, or research-related field required.
  • Bachelor's degree plus a minimum of three (3) years experience as a Research Coverage Analyst.
*In lieu of a Bachelor's degree, an Associate's degree and two (2) additional years' experience as a Research Coverage Analyst, a total of five (5) years' experience will be considered.
Minimum Skills/Specialized Training Required:
Data Analysis:
  • Strong ability to analyze and interpret complex data sets related to coverage analysis and clinical trial protocols.
Project Management:
  • Proven ability to manage multiple complicated projects simultaneously with minimal supervision, ensuring timely completion and adherence to quality standards.
Effective Communication:
  • Excellent interpersonal skills to interact professionally with a diverse range of internal team
  • members and external partners in a timely manner.
Regulatory Knowledge:
  • In-depth understanding of Medicare's Clinical Trials Policy and related regulations, with the ability to apply this knowledge in practical scenarios.
Attention to Detail:
  • Exceptional attention to detail to ensure accuracy and compliance in coverage analyses and related documentation.
Problem-Solving:
  • Strong analytical and critical thinking skills to identify issues and propose effective solutions.
Adaptability:
  • Ability to adapt to changing priorities and evolving regulatory requirements within the clinical research environment.
Documentation Review:
  • Proficient in reviewing and assessing various documents, such as contracts and informed consent forms, for consistency and compliance.