Medicare Coverage Analyst Sr

Job Title
Medicare Coverage Analyst Sr


Requisition Number
RE50150


Working Title
Clinical Trials Coverage Analyst Sr


Department Name
40133:Clinical Research Support Office


Work Location
Lexington, KY


Grade Level
46


Salary Range
$52,021-85,800/year


Type of Position
Staff


Position Time Status
Full-Time


Required Education

BA



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


Required Related Experience

4 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

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 Sr position. This position performs detailed reviews of complex study protocols, budgets, informed consent forms, contracts, FDA documents, and other relevant study documents to determine qualifying status according to Medicare Clinical Trial Policy, and conducts a comprehensive coverage analysis for all applicable study protocols across the enterprise. It determines what items of service are billable after reviewing Medicare Benefits Policy, relevant National Coverage Decisions (NCDs), Local Coverage Decisions (LCDs), Code of Federal Regulations, state law, professional practice guidelines, and, when necessary, consulting with the Medicare Administrative Contractor (MAC) for the region. This role is responsible for developing and delivering professional coverage analysis and financial calendars where the coverage analysis is not applicable, according to national patient care services billing standards. The position will provide guidance to study teams about proper coding and billing for procedures in the Epic system within the context of clinical research and based on the state and national standards. The role is responsible for following the UK established policies for patient care services, including documentation in the medical record and documenting coverage analysis justifications.



Under the direct supervision of the Director of Clinical Research Administration and Billing Integrity, the Research Coverage Analyst helps develop and refine processes to integrate the coverage analysis workflow with UKHC and UK related processes and teams. The role performs its work collaboratively with investigators, study teams, clinical research coordinators, and other research staff while serving as a resource on coverage analysis as an integral component to maintaining proper billing integrity and compliant standards. This role will also cross-train on clinical trial budget development and charge review process.



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/equivalenciesInternal Employee Being Considered



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



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



Deadline to Apply
05/07/2025


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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.