Research Billing Quality Review Analyst - Hybrid - 130902

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 Research Billing Quality Review Analyst oversees comprehensive audits of accounts with research charges submitted post-claim to Medicare, Medi-Cal, and Commercial insurance payers, as well as post-statement invoicing for research studies. Acting as the primary liaison to physicians, researchers, internal UCSD Health stakeholders, and patients, the incumbent ensures adherence to Medicare's Clinical Trial Policy, federal regulations, and contractual agreements with pharmaceutical and third-party entities. Additionally, the Specialist serves as a subject matter expert in research billing workflows and system processes, contributing optimization strategies.

Key Responsibilities:

• Collaborate with research clinical staff, Patient Financial Services (PFS), Patient Access, Health Information Management (HIM)/Coding, Physician Billing Group, and third parties to maintain compliance with clinical trial billing workflows.
• Offer guidance and serve as a resource on clinical trial regulations and best practices to internal and relevant external parties.
• Address internal department billing challenges and provide support at designated meetings to facilitate cross-departmental alignment.
• Conduct annual billing training for research staff and as-needed training for new hires.

In addition to conducting audits, the Research Billing Quality Review Analyst synthesizes regulations and industry publications, assisting in the development of training materials and other departmental guidance documents. Operating autonomously, the Specialist conducts regular, ad hoc, and for-cause audits to ensure compliance with applicable federal and state laws, regulations, guidance, and internal policies and procedures. Furthermore, the Specialist provides detailed reports of findings and contributes to the development of corrective and preventative action plans.

• Seven (7) years of related research billing audit experience, education/training, in an academic health system OR a Bachelor's degree in related area plus three (3) years of related research billing audit experience experience/training.

• Thorough knowledge of the practices, procedures, and concepts of the healthcare revenue cycle and its component operations, including billing, collections, charge capture, contractual adjustments, third-party reimbursements, and cash management.

• Thorough understanding of the issues, processes, reporting instruments, metrics, analytics, and other tools and techniques involved with measuring and analyzing the revenue cycle.

• Detail oriented, with proven ability to effectively manage time, see tasks and projects through to completion, organize competing priorities, and effectively address complex, urgent issues as they arise.

• Strong skills in report development, dashboard design, and various software tools specific to healthcare revenue cycle management. Skills in common database, spreadsheet and presentation software.

• Strong communications skills, with the ability to interpret and convey complex clinical finance information in a clear, concise manner. Ability to prepare compelling and informative reports and presentations.

• Strong analytical and problem-solving skills, with the ability to evaluate the effectiveness of workflows and systems and propose innovative solutions.

• Strong interpersonal skills, with the ability to collaborate effectively on complex projects in a team environment with staff from a wide variety of business and clinical areas.

• Proven ability to work with managers, serving as a technical resource, providing recommendations and advice on regulatory changes, and industry trends and developments in revenue cycle management.

• Lean Six Sigma Green Belt or higher for Healthcare.

• Coding certification (AAPC or AHIMA).

• Research compliance certification.

• Epic research billing certification.

• Velos CTMS experience.

• 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.