Clinical Research Revenue Integrity Analyst

Inova Office of Research is seeking a dedicated Clinical Research Revenue Integrity Analyst to join the team. This role will be full-time Monday - Friday, Hybrid Day shift.

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
• Retirement: Inova matches the first 5% of eligible contributions - starting on your first day.
• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities.

Clinical Research Revenue Integrity Analyst Job Responsibilities:

• Review charges daily that are in the Epic charge review work queues and Epic reports to segregate them as research paid, routine care, or not study related.
• Apply appropriate billing modifiers and other requirements for billing research-related charges to federal and non-federal payors.
• Processes charge related corrections, additions, and removals in Epic and the OnCore CTMS to ensure organizational compliance.
• Collaborate with the PI/study team, Office of Research staff, and other Inova departments to determine accurate Current Procedural Terminology (CPT) coding for billable procedures. Serves as a resource to communicate with non-research departments to determine correct coding and charges.
• Analyze clinical trial documents to determine if research studies meet the requirements to be considered qualifying clinical trials according to federal guidelines
• Perform Coverage Analysis to determine which billable procedures are Routine Care, and thus, billable to Medicare and other third-party payers based on CMS and other federal guidelines, National/Local Coverage Determinations, and professional practice guidelines
• Collaborate with internal stakeholders to determine accurate Current Procedural Terminology (CPT) coding and other billable items/rules applicable to protocol requirements
• Review study documents to prepare a billing grid for all medical procedures and services required in a clinical research study by ensuring all billable services required by the research study are included in the study's billing grid
• Perform quality control reviews of approved billing grids, finalized budgets, informed consent forms, and clinical trial agreements to ensure harmonization across documents

Clinical Research Revenue Integrity Analyst Additional Requirements:

• Work schedule: 8-hour shift (Monday - Friday; Hybrid Day shift).
• Education: Bachelor degree in relevant field.
• Experience: Four (4) years' experience in coverage analysis and budget negotiations and /or clinical research.

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