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Overview
To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
Analyzes and resolves complex clinical trial patient accounts. Responsible for establishing, updating and implementing procedures regarding the billing of clinical trials. Responsible for identifying work flow issues, developing suggestions for improvement, and providing in-services to other areas regarding the clinical trial processes. Produces a variety of computerized reports regarding the clinical trail processes, including registration, billing, and collections. Works closely with various departments throughout the SBO, Hospital, and Yale University to ensure that departmental financial and compliance objectives are achieved. Responsible for ensuring that all charges related to clinical trials are billed appropriately to either insurance(s) or the Clinical Trial Coordinator/Principal Investigator by reviewing multiple computer systems and interpreting clinical treatment plans for each patient within each clinical trial in conjunction with the various services being charged for hospital services.
EEO/AA/Disability/Veteran
Responsibilities
Performs detailed analysis of potential clinical trial accounts by identifying charges billable to insurance and separating charges that are part of the clinical trial by creating the appropriate accounts. Uses good planning and problem-solving methods and resourcefulness to resolve issues (including any system problems). Follows up on accounts by contacting both internal and external sources to obtain the clinical information needed to substantiate charges as part of the clinical trial.
Utilizes various computer systems to access daily work file to correctly identify accounts with potential clinical trial charges and establishes any necessary accounts to be billed appropriately.
Initiates effective follow up by contacting clinical trial coordinators and/or patients to obtain additional information necessary to resolve any issues holding up the bill.
Contacts Medical Records, reviews clinical information available on a variety of systems and interprets clinical treatment plans and protocols for the patient to determine the status of the charges.
Identifies and resolves edits in the systems which may be holding up the billing process.
Ensures subsequent follow up activity is established and adheres to a timely schedule to follow up on accounts.
Documents all follow up activity on the account in the system in a clear concise manner, in order to aid in the resolution of the account and for future reviews.
Using excellent analytical and decision-making skills manages the clinical trial accounts in the file. Determines which accounts should be billed to clinical trials or to health insurance, written off, re-billed or appealed to health insurance and refer to the appropriate parties. Looks for ways to continually to improve the process resulting in charges being billed to either clinical trials or health insurance appropriately.
Demonstrates a thorough knowledge and understanding of each phase of the process and a familiarity with all systems involved. This includes a complete understanding of clinical trial procedures and third party billing requirements in order to effectively carry out assigned duties.
Determines appropriate reimbursement methodology and applies to clinical trial accounts according to established protocol/trial.
Verifies the accuracy of proration and makes adjustments to accounts as necessary and with respect to developed fee schedule.
When identifying changes billable to third parties, ensures that the necessary edits are addressed and correct modifiers are added to charges on the account.
Follows each account in file to final resolution by identifying it as a possible write-off, re-bill or appeal and refers to the appropriate party to complete the process in a timely manner.
Recognizes the key issues that impact the identification of the clinical trial accounts in order to effectively process these accounts and provides feedback to other departments, using written memos, PowerPoint presentations and other report formats. Relates pertinent information and concerns to the protocol investigator and manager, ensuring that all research is structured with respect to the patient's needs and to the positive outcome of the trial.
Analyzes correspondence and problems as they pertain to the clinical trial accounts. Initiates requests and follows up with the clinical trial coordinator or principal investigator when necessary. Takes corrective action to ensure timely billing and reimbursement of these accounts accurately documenting all actions in the system.
Reviews and responds to internal and external mail/data or electronic mail in a timely manner.
Ascertain specific billing requirements by a particular third party regarding clinical trials insuring that charges are correctly billed to third party insurance whenever possible.
Takes all necessary corrective action to facilitate the resolution of disputed clinical trial charges insuring that they are always applied to the appropriate account to be billed and reimbursed.
Tracks authorizations for procedures and pre-certification for treatment in clinical trial that when required.
Assists the principal investigator in assessing the resource needs for the protocol, as needed. Reviews the research and treatment plan with the protocol investigator, coordinators and other members of the clinical trial team, ensuring that communication regarding these accounts takes place
Maintains and updates clinical trial billing procedures in accordance with Clinical Trial Protocols, managed care companies, third party insurers, state and federal billing regulations and guidelines.
Updates procedures as required to insure that charges are accurately applied to the appropriate accounts and billed according the regulations.
Acts as a resource for access and billing staff throughout the department on matters of clinical trial billing.
Reviews protocols to ensure that all documents are in concert with the YNHH procedures and financial interests. Collaborates with university clerical staff with regard to data entry and account accuracy.
Keeps abreast of changing regulations and follows established rules and guidelines by working closely with various departments throughout the hospital and Yale University.
Understands all operative aspects of the protocol process in order to establish whether charges belong to clinical trial or should be billed to insurance.
Identifies the issues and provides in-service to the upfront departments to ensure that information is obtained properly in order to reduce and eliminate improper identification of accounts
Produces monthly statistics utilizing report writer and/or spreadsheet software. Performs quality assurance on clinical trial accounts and advises supervisor of pertinent information or problems that arise to maintain a smooth operation. Exhibits a positive attitude, as demonstrated by attending meetings and actively participating, assuming responsibility for continued learning and development and contributing to group goals and performs all other related duties.
Utilizes Excel (or other report writing software) to produce monthly status reports of clinical trial accounts.
Is accountable for ensuring exceptional, quality service that is coordinated, efficient and supports the desired research and clinical outcomes.
Attends and actively participates in staff meetings and attends all mandatory continuing education and in-service classes.
Assumes responsibility for continued learning, skill development and goal setting in collaboration with the supervisor.
Informs supervisor of any pertinent information or problems as they arise to ensure efficient and effective operation of the department Qualifications EDUCATION Bachelor's degree in Business Administration or related area preferred. CPC, CPC-H coding strongly preferred.
EXPERIENCE
Minimum of 3 years of billing, claims management, and/or Coding experience. Clinical trials experience preferred. Previous experience with budgeting, reimbursement and system analysis preferred.
SPECIAL SKILLS Strong professional communication, organizational and time management skills.
Proficient with software packages (ie. Word processing, databases, spreadsheets, PowerPoint).
Presentations and written communication skills necessary.
Extensive knowledge of third party (managed care and governmental) insurance billing regulations directly related to clinical trials.
Ability to perform detailed analysis quickly and accurately.
YNHHS Requisition ID 187204 Originally posted on Himalayas