Research Billing Charge Review Analyst - Remote - 121672

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.

• Seven (7) years of related experience, education/training, OR a Bachelor's degree in related area plus three (3) years of related experience/training. Related experience: clinical research billing, research administration(grants and contracts) or research compliance.

• Experience and proven success in billing and / or collections processes, concepts, systems and external regulations. Knowledge of medical terminology and coding

• HFMA Certified Revenue Cycle Representative (CRCR) highly desired.
• AAPC or AHIMA coding certification highly desired.
• Lean Six Sigma Green Belt or higher highly desired.
• Two (2) years of work experience in healthcare finance (patient billing, collections, account reconciliations, etc.).
• Knowledge and experience with aspects of third party reimbursement (Medicare, Blue Cross, Medicaid).
• Working knowledge of medical terminology.
• Demonstrated accuracy and precision, attention to detail, and exceptional organizational skills are essential.
• Ability to interpret research protocol information highly.
• Ability to manage large quantities of data in a manner which facilitates sharing of information.
• Ability to handle high volume of work with changing priorities and constant interruptions and establish priorities and deadlines.

• Must be able to work various hours and locations based on business needs.
• Employment is subject to a criminal background check and pre-employment physical.