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.
- 1. 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.
- 1.1 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.
- 2. 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.
- 2.1 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.
- 3. 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.
- 3.1 Reviews and responds to internal and external mail/data or electronic mail in a timely manner.
- 4. 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.
- 4.1 Updates procedures as required to insure that charges are accurately applied to the appropriate accounts and billed according the regulations.
- 5. 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..
- 5.1 Utilizes Excel (or other report writing software) to produce monthly status reports of clinical trial accounts.
Bachelor's degree in Business Administration or related area preferred. CPC, CPC-H coding strongly preferred.
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.
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.