Budget & Coverage Analyst - Clinical Research
Job description
Tampa General Hospital was named the #1 hospital in Tampa Bay by U.S. News & World Report, 2020-2021, and recognized as one of America's Best Hospital in five medical specialties: Cardiology & Heart Surgery, Diabetes & Endocrinology, Gastroenterology & GI Surgery, Nephrology, and Orthopedics. Tampa General Hospital has been designated a Magnet Hospital by the American Nurses Credentialing Center (ANCC), the highest recognition for nursing excellence, for the fourth consecutive time – an accomplishment that fewer than one percent of hospitals nationwide have earned. TGH is accredited by The Joint Commission and was awarded disease-specific certification in five medical specialties. TGH is also accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). *Air transport provided by Metro Aviation, Inc.
Under the supervision of the Research Finance Manager or the Lead Clinical Research Budget and Coverage Analyst, provides analysis of clinical research budgets and payer coverage. Responsible for performing job duties in accordance with mission, vision and values of Tampa General Hospital.
- Creates coverage analysis and full internal budget for every study.
- Identifies and communicates funding gaps to management.
- Coordinates with study teams and with appropriate ancillary/support units on pricing to create budgets.
- Maintains knowledge of all the relevant billing rules and guidance.
- Conducts budget negotiations with industry sponsors, grantors and other funding sources.
- Maintains regular and predictable attendance.
- Completes other related duties as assigned in order to meet the goals of the department and institution.
Bachelor’s degree or higher is required, in area of clinical health sciences or related field, such as Doctor of Pharmacy (Pharm.D) or Bachelor of Science in Nursing (BSN). Requires a minimum two (2) years’ experience (or equivalent education) in clinical research or related field and prefer experience in billing, coding, coverage determinations, budgeting, and knowledge of research billing regulations.
- Strong medical terminology skills
- Experience utilizing clinical literature to support determination of study protocol activities.
- Knowledge of medical claims coding practices and clinical processes including Medicare, Medicaid and insurance billing with UB04 and HCFA 1500
- Knowledge of clinical research, research revenue cycle, clinical trial budgeting and billing rules, related contract negotiations, and related state and federal laws and regulations such as Medicare coverage rules and application of NCDs and LCDs, Medicare device (IDE) study coverage approval process, NCD 310.1. Must also have an understanding of Medicaid rules and regulations.
- Experience with reviewing and understanding FDA and Medicare regulations related to clinical trials including trials using Investigational New Drugs (IND) and Investigation Device Exemptions (IDE); and experience interpreting research contracts, study budgets, clinical protocols, and consent forms to extrapolate billing/coverage data is required.
- Strong analytical problem solving skills
- Excellent communication skills to include oral and written comprehension and expression.
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