Medicare Coverage Analyst Lead

Job Title
Medicare Coverage Analyst Lead


Requisition Number
RE50183


Working Title
Clinical Trials Coverage Analyst Team Lead


Department Name
40133:Clinical Research Support Office


Work Location
Lexington, KY


Grade Level
47


Salary Range
$57,158-94,286/year


Type of Position
Staff


Position Time Status
Full-Time


Required Education

MA



Click here for more information about equivalencies:
https://hr.uky.edu/employment/working-uk/equivalencies


Required Related Experience

5 yrs



Required License/Registration/Certification

None



Physical Requirements

Ability to sit for extended periods of time utilizing mouse, keyboard, computer, and telephone. Ability to lift, push, or pull objects up to 50 lbs. Repetitive motion.



Shift

Fully remote
Monday – Friday; 8:00 am to 5:00 pm.



Job Summary

IEBC: Internal Employee Being Considered

This position is eligible to be fully remote.


The University of Kentucky Clinical Research Support Office (CRSO) provides support to investigators and study teams conducting clinical research, including clinical trials. Services provided by the CRSO include maintaining a clinical trial management system (CTMS), conducting coverage analysis, developing study budgets, negotiating payment terms with sponsors, and regulatory services.




The CRSO is seeking qualified candidates for a Medicare Coverage Analyst Lead position. The position will assign daily work for coverage analysts, process all new studies and amendments, and conduct triage of each submission to determine the level of build. Maintain daily metrics for new studies and amendments. The position performs some complex coverage analysis and billing reviews and performs quality control for all CAs and billing grids before study team’s approval. Organize and participate in all CA and billing meetings with study teams, and coordinate the intake meetings as needed. Performs Tier 1 notifications – monitoring periodically in compliance with the UKHC policy for Tier 1 processing. Communicates with the Director any issues related to billing to approve CAs and consult and work closely with the Director to resolve billing in Epic as needed. Resolve all inquiries related to coverage analysis and billing clinical research for external partners. Maintain the process touch times and task lists to ensure the products are completed timely and accurately. Provide ongoing training and education to new staff, new study teams and serve as an expert in coverage analysis working in collaboration with the Director.

The position performs detailed reviews of complex study protocols, budgets, informed consent forms, contracts, FDA letters, and other relevant research documents to determine qualifying status, according to the Centers for Medicaid and Medicaid (CMS) standards as required by legal provisions for the Medicare program.

The University of Kentucky uses equivalencies in determining if a potential applicant meets the minimum education and experience. Related experience can be substituted for education. Click here for more information about equivalencies: http://www.uky.edu/hr/employment/working-uk/equivalencies



Skills / Knowledge / Abilities

Clinical Trial Protocol knowledge, medical coding or billing, medical terminology, attention to detail, ability to work independently, collaboration, strong competency in Microsoft Office Programs, detailed understanding of the Epic billing system, proficient in OnCore MCA and Calendar consoles, project tracking and management, development of converge analysis, understanding medical records documentation, understanding of medical claims, intensive coverage analysis or research billing integrity training preferred.



Does this position have supervisory responsibilities?
No


Preferred Education/Experience

It is preferred that the candidate have work experience in a clinical setting that included research coverage analysis, clinical research budgeting, clinical research management, and medical coding or billing. Candidates with coding knowledge in specific disease areas including oncology, cardiology, neurology etc. are preferred.

CA Certification or training in OnCore, Epic or Coding Certification or training
Advarra CA certification within the first year



Deadline to Apply
05/13/2025


Our University Community

We value the well-being of each of our employees and are dedicated to creating a healthy place for everyone to work, learn and live. In the interest of maintaining a safe and healthy environment for our students, employees, patients and visitors the University of Kentucky is a Tobacco & Drug Free campus.


As an Equal Opportunity Employer, we strongly encourage veterans, individuals with disabilities, women, and all minorities to consider our employment opportunities.


Any candidate offered a position may be required to pass pre-employment screenings as mandated by University of Kentucky Human Resources. These screenings may include a national background check and/or drug screen.