Clinical Research Coverage Analyst

Who is Saint Louis University? Founded in 1818, Saint Louis University is one of the nation's oldest and most prestigious Catholic universities. SLU, which also has a campus in Madrid, Spain, is recognized for world-class academics, life-changing research, compassionate health care, and a strong commitment to faith and service.

Job Summary

Under general direction, provides education and training to the clinical research community of the School of Medicine regarding clinical research studies; contributes to compliant research billing practices by making determinations of qualifying clinical trial (QTC) status and performing detailed coverage analysis (CA). Promotes and supports accurate billing practices to be compliant with Medicare and third-party payment rules. Assists in streamlining research study activation and ensures compliance with federal/state and local regulations as well as University guidelines.

Primary Job Duties

• Reviews clinical trial protocols to determine if each new study is a qualified clinical trial pursuant to CMS policy; creates a detailed Coverage Analysis using clinical trial documents to designate which procedures/services may be "routine care" and billable to patient insurance and which should be billed to the study sponsor based on relevant regulations and determinations. Serves as National and Local Coverage Determination (NCD and LCD) subject matter expert. Interfaces with study teams and sponsors to resolve discrepancies in specific protocol assessments. Interfaces with study teams and principal investigators to assist with coverage analysis determinations. Performs document review for alignment for each study.

• Acts as liaison with partnering hospital to ensure each new study is built in the electronic medical record (EMR) system: submits build forms, maintains spreadsheet of builds, requests updates / corrections as needed.

• Provides education for clinical research within the University community; conducts training sessions and develops tools and standardized policies related to the conduct of clinical research; develops a training program for the University clinical research coordinators to conduct clinical research.

• Assists with the management of clinical trials organization; attends meetings; performs other duties as assigned.

Knowledge, Skills, and Abilities

• Knowledge of regulations and guidelines related to clinical research

• Working knowledge of clinical research and multiple medical conditions

• Working knowledge of Medicare/Medical billing processes

• Organizational, analytical, and decision-making skills

• Excellent verbal and written communication skills

• Ability to read and comprehend complex materials

• Detail oriented with ability to independently research source materials and develop reasonable approaches to issues as they arise

• Ability to speak to groups, conduct educational sessions, and adapt teaching styles to learners

• Ability to operate computer and various software

• Ability to maintain confidentiality

Minimum Qualifications

• Bachelor's degree, supplemented with three (3) years of related experience, preferably in the field of clinical research; or Associate's degree, supplemented with five (5) years of related experience, preferably in the field of clinical research. If the candidate does not have a degree, seven (7) years of related experience is required, preferably in the field of clinical research.

Preferred Qualifications

• 1-2 years' direct experience completing Medicare Coverage Analysis

• Experience with research activity in an academic medical center

• CPT coding experience

This role is available for hybrid or remote work in the following states: Alabama, Arizona, California, Colorado, Illinois, Indiana, Kansas, Maine, Massachusetts, Michigan, Minnesota, Missouri, New Jersey, North Carolina, Ohio, Oklahoma, Rhode Island, Tennessee, Texas, Utah, Virginia, West Virginia, and Wisconsin.

The salary range for this position is $46,720 - $70,080, pay will be dependant on experience and qualifications. In addition to competitive pay, this role includes a comprehensive benefits package as part of being a valued staff member at Saint Louis University.

Function

Scheduled Weekly Hours:

Saint Louis University is an equal opportunity/affirmative action employer. All qualified candidates will receive consideration for the position applied for without regard to race, color, religion, sex, age, national origin, disability, marital status, sexual orientation, military/veteran status, gender identity, or other non-merit factors. If accommodations are needed for completing the application and/or with the interviewing process, please contact Human Resources at 314-977-5847.