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QA / MCA Operations Associate

2 months ago

Lebanon, United States Dartmouth Health Full time

Overview

Completes various tasks related to Quality Assessment (QA) and Medicare Coverage Analysis (MCA) management of clinical trials. These tasks include, but are not limited to: QA of Medicare Coverage Analyses (MCAs) for all clinical trials, maintenance of the Dartmouth study MCA/QA related document management, assisting research teams with QA of all studies, routing of MCA documentation for approval, ensuring all required internal and external approvals are granted prior to release of the study related expenses, and other related study management activities as instructed by the CTBO Manager.

Responsibilities

Maintain a detailed understanding of Medicares Clinical Trial Policy (NCD310.1) and related guidance documents

Maintain a detailed understanding of National Coverage Determination and Local Coverage Determinations

Perform an initial quality check on all studies to identify inconsistencies after Clinical Research Coverage Team completes their initial study validation in accordance to NCD310.1 and Medicare benefit policy guidelines on all new studies and amendments

Performs final consistency check/harmonization on all study types. This includes an extensive review with studies that have a fully executed Contracts/Award, including budgets, IRB Approved Informed Consent, FDA documents and patient calendars to ensure compliance with CMS and FDA regulations and guidelines

Analyze and report on data from Quality Control activates to identify trends, issues, and risk areas for training or policy reviews

Assist with implementing strategies to achieve and maintain the quality and compliance goals of CTO Leadership

Prepare reports for CTO Leadership and administrators.

Provide annual group educations and training on MCA Guidelines, and QC compliance awareness

Serve as liaison to Revenue Management Coding Operations

Serve as knowledge resource for CMS issue resolution; may provide guidance, in coordination with Clinical Research Coverage Analysis, to Revenue Management Bill Reviewer

Assist in developing Research Quality Control policies and procedures

Perform Quality Assurance through audits to reveal inaccuracies, such as outdated codes and potentially inaccurate billing in effort to obtain proper reimbursement and maintain regulatory compliance

Regularly update and work with Clinical Trial Management System OnCore, the Research Database, for each clinical research study, in compliance with DH policies, procedures, and standards

Qualifications

Associates degree with a minimum of 1 year of direct experience or comparable competency in professional or facility chart abstraction, CPT and ICD-9 coding, charge documentation and charge capture resolution, or the equivalent in education and experience required.

Knowledge of government documentation, coding and reimbursement guidelines required.

PATH issues and third-party payer reimbursement practices expertise. Experience in academic health care auditing preferred.

Strong organizational and analytical skills needed and ability to effectively communicate (both orally and in writing) with all levels of staff crucial.

Attention to detail essential.

Required Licensure/Certifications

CPC, CCS or CCS-P certification preferred.

Area of Interest:Professional/Management;

FTE/Hours per pay period:1.00 - 1.00 - 40 hrs/week;

Shift:Day;

Job ID:24143;

Dartmouth Health is an Affirmative Action and Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

Dartmouth Hitchcock Medical Center and Dartmouth Hitchcock Clinics comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. We do not exclude or treat people differently because of race, color, national origin, age, disability, or sex.