Budget & Coverage Analyst

2 days ago

Tampa, FL, United States Tampa General Hospital Full time

Under the supervision of the Research Finance Manager or the Lead Clinical Research Budget and Coverage Analyst, provides analysis of clinical research budgets and payer coverage. Responsible for performing job duties in accordance with mission, vision, and values of Tampa General Hospital.

  • Creates coverage analysis and full internal budget for every study.
  • Identifies and communicates funding gaps to management.
  • Coordinates with study teams and with appropriate ancillary/support units on pricing to create budgets.
  • Maintains knowledge of all the relevant billing rules and guidance.
  • Conducts budget negotiations with industry sponsors, grantors, and other funding sources.
  • Maintains regular and predictable attendance.
  • Completes other related duties as assigned in order to meet the goals of the department and institution.
Qualifications
  • Bachelor's degree or higher is required, in area of clinical health sciences or related field, such as Doctor of Pharmacy (PharmD) or Bachelor of Science in Nursing (BSN).
  • Requires a minimum two (2) years' experience (or equivalent education) in clinical research or related field and prefer experience in billing, coding, coverage determinations, budgeting, and knowledge of research billing regulations
  • Associate's degree with at least 4 years of experience will be considered.
  • Strong medical terminology skills
  • Experience utilizing clinical literature to support determination of study protocol activities.
  • Knowledge of medical claims coding practices and clinical processes including Medicare, Medicaid, and insurance billing with UB04 and HCFA 1500
  • Knowledge of clinical research, research revenue cycle, clinical trial budgeting and billing rules, related contract negotiations, and related state and federal laws and regulations such as Medicare coverage rules and application of NCDs and LCDs, Medicare device (IDE) study coverage approval process, NCD 310.1.
  • Must also have an understanding of Medicaid rules and regulations.
  • Experience with reviewing and understanding FDA and Medicare regulations related to clinical trials including trials using Investigational New Drugs (IND) and Investigation Device Exemptions (IDE); and experience interpreting research contracts, study budgets, clinical protocols, and consent forms to extrapolate billing/coverage data is required.
  • Strong analytical problem-solving skills.
  • Excellent communication skills to include oral and written comprehension and expression.

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