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Research Billing Charge Review Analyst - Remote - 121672
| University of California - San Diego Medical Centers|
United States, San Diego
|March 28, 2023|
UCSD Layoff from Career Appointment: Apply by 02/27/23 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor.
Special Selection Applicants: Apply by 03/09/23. Eligible Special Selection clients should contact their Disability Counselor for assistance.
Candidates hired into this position may have the ability to work remotely.
UC San Diego Health's Revenue Cycle department supports the organization's mission to deliver outstanding patient care and to create a healthier world - one life at a time. We are a diverse, patient-focused, high-performing team with a commitment to quality, collaboration, and continuous improvement that enables us to deliver the maximum standard of care to our patients. We offer challenging career opportunities in a fast-paced and innovative environment and we embrace individuals who demonstrate a deep passion for problem-solving and customer service.
The Clinical Research Charge Review Analyst will promote and facilitate a culture of financial solvency and compliance through accurate and timely clinical charge review (both technical and professional) for all study participants involved in clinical research activities at UCSD and includes mixed billed services(standard of care and research). This involves using research billing documentation< Epic EMR and/or Velos CTMS to support the clinical research revenue cycle. This includes, but is not limited to, comparing charges to the charge router, internal documentation and seeking concurrence from research staff and physicians to confirm accurate charge posting. Reviews clinical research protocols and determines whether the charges meet the necessary criteria for billing of routine costs to the patient/insurance.
Analyzes and interprets governmental and commercial payer guidelines in conjunction with the study documentation to determine the appropriate payer for each test/procedure required by the research protocol. Maintains up-to-date knowledge on Medicare, Medicaid, and other regulatory requirements pertaining to accepted coverage, billing, and reimbursement policies and standards. Reviews study documentation, medical records, and study coverage analysis grid to appropriately segregate research charges from charges billable to the patient/insurance once the patient visit has been completed and charges appear in the electronic health record billing system. Acts as an expert resource for preparation of claims for patients participating in research studies. Reviews protocol amendments to determine whether changes to the study billing grids will result in rebilling.
Facilitates change in the research revenue cycle process and related interfaces through communication with study teams, clinical departments, revenue integrity/charge description master, finance, information services, compliance, physician group and patient financial services to ensure the integrity and accuracy of medical records and hospital/physician bills.Communicates relevant governmental and commercial policy rules to study teams and appropriate service lines for reimbursement of coverage for services on research patients. Provides education, feedback, and clinical expertise to study teams and clinical departments to ensure consistency and accuracy in research charging and billing process. Collaborates with appropriate personnel to identify and remedy issues with particular studies and/or patient bills. Works with appropriate personnel to manage and appeal rejections/denials on clinical research patients. Incorporates knowledge gained from such activities to enhance front-end processes. Independently works on additional projects as requested.MINIMUM QUALIFICATIONS
Pay Transparency Act
Annual Full Pay Range: $48,900 - $102,300 (will be prorated if the appointment percentage is less than 100%)
Hourly Equivalent: $23.42 - $48.99
Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).