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Sr Research Medicare Coverage Analyst - Office of Research Administration

Requisition # 19004278 Apply Now

Our Senior Research Medicare Coverage Analyst is a professional position working under the general supervision of the Associate Director, Clinical Trials Administration Office to support the institutional goal of compliance in clinical research budgeting and billing. In this exciting but highly important role, you will provide high-level professional support in the growing efforts to conduct prospective Medicare Coverage Analysis for all clinical research studies.

You day to day job duties and responsibilities will include:
  • Screening research protocols to determine whether a formal Medicare Coverage Analysis (MCA) is required.
  • Collaborate with investigators to determine whether each study is a qualifying clinical trial under CMS Clinical Trial policy.
  • Based on CMS policy and National and Local Coverage Determinations, as well as professional practice guidelines, reviews clinical research protocols and determines which procedures are routine, and therefore, billable to Medicare and other third party payers. This often requires extensive independent research to identify applicable practice guidelines. This also requires the incumbent to be cognizant of changes related to the CMS interpretations and implementation of its policies, which have been controversial.
  • Completely and effectively documents MCA determinations to support the decision-making process. This documentation may be subject to inspection by CMS and regulatory agencies.
  • Reviews patient informed consent forms to ensure that the document accurately informs patients which procedures will be billed to their insurance vs. those that will be covered by the study budget, in accordance with the MCA.
  • Provide training and consultation to investigators and research staff and managers on regulations and policies related to Medicare coverage in research. Also provides consultation in the development of investigator-initiated protocols with respect to implications for Medicare billing.
  • Attend IRB meetings to provide education to IRB members and address questions raised regarding the Medicare Coverage Analysis and associated informed consent language. Coordinates with IRB staff and the investigator if the IRB raises issues regarding the determinations of the Medicare Coverage Analysis and/or consent form language.
  • Collaborate and communicate effectively with investigators and research staff, Patient Financial Services, IRB and Chief Compliance Officer with respect to Medicare Coverage Analysis issues and determinations.
  • Assist with the development of institutional policies and procedures pertaining to clinical research budgeting and billing, including the MCA process.
  • Keep current with FDA and Medicare regulations and CA state laws applicable to clinical research billing.
  • Conduct special department related projects as they are assigned.
Experience:
  • Minimum five (5) years experience in clinical research conduct, administration or coordination
Educational Requirements:
  • Bachelor’s Degree in healthcare or science related discipline. Nursing Degree and RN licensure preferred.
  • Minimum five years experience in clinical research conduct, administration or coordination.
  • License/Certification/Registration Requirements: RN preferred
License/Certification/Registration Requirements: 
  • RN Preferred
  • Working Title: Sr Research Medicare Coverage Analyst - Office of Research Administration
  • Department: Office of Research Admin
  • Business Entity: Academic / Research
  • City: Los Angeles
  • Job Category: Academic / Research
  • Job Specialty: Academic/Research Services
  • Position Type: Full-time
  • Shift Length: 8 hour shift
  • Shift Type: Day
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Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.

Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.

At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu). For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through March each year) as a condition of employment, and annually thereafter as a condition of continued employment.

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