Research Billing Compliance Specialist

Research Billing Compliance Specialist

JOB SUMMARY:
Coordinates with departments to develop billing plans to help ensure financial compliance in research, under occasional guidance.


KEY RESPONSIBILITIES:

• Assists with developing and implementing compliance and financial audits of clinical research.
• Creates and maintains the reporting, education, and training for research billing compliance.
• Develops processes to transmit and coordinate billing information through regulatory and compliance teams.
• Assists in reviewing financial records, contracts, and other information necessary to ensure compliance with billing requirements.
• The responsibilities listed are a general overview of the position and additional duties may be assigned.

TECHNICAL CAPABILITIES:

REGULATORY COMPLIANCE (INTERMEDIATE): - Demonstrates knowledge of the appropriate rules and regulations and apply them in difficult, stressful and complex situations. Able to interpret and explain rules and regulations that are ambiguous or unclear. Directs others in interpreting rules and regulations on the job and trains others in them.

PROBLEM SOLVING (INTERMEDIATE): - Uses critical thinking and process improvement i.e. coaches and mentors development of problem statement, describes current state, identifies root causes, creates future state, coaches and mentors development of solutions and action plans with a sustainability plan. Applies appropriate tools to address issues.

CODING KNOWLEDGE (FUNDAMENTAL AWARENESS): - Ability to assign and interpret ICD-10-CM/PCS coding classification systems and MS-DRG and APR-DRG prospective payment and severity systems.

REVENUE CYCLE (FUNDAMENTAL AWARENESS): - Knowledge of the financial process to track patient care from registration and scheduling to the final payment of a balance.

CLINICAL KNOWLEDGE (INTERMEDIATE): - Knowledge of patient care including patient assessment and treatment, care planning, patient education and evidence based practice. Understanding of medical terminology and documentation.

CORE ACCOUNTABILITIES:

• Organizational Impact: Executes job responsibilities with the understanding of how output would affect and impact other areas related to own job area/team with occasional guidance.
• Problem Solving/ Complexity of work: Analyzes moderately complex problems using technical experience and judgment.
• Breadth of Knowledge: Has expanded knowledge gained through experience within a professional area.
• Team Interaction: Provides informal guidance and support to team members.