Naples Comprehensive Health (NCH)
Naples Comprehensive Health (NCH)
ABOUT NCH
NCH is an independent, locally governed non-profit delivering premier comprehensive care. Our healthcare system is comprised of two hospitals, an alliance of 700+ physicians, and medical facilities in dozens of locations throughout Southwest Florida that offer nationally recognized, quality health care.
NCH is transforming into an Advanced Community Healthcare System(TM) and we’re proud to: Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan.
Join our mission to help everyone live a longer, happier, healthier life. We are committed to care and believe there's always more at NCH – for you and every person we serve together. Visit nchjobs.org to learn more.
JOB SUMMARY
The Research Billing Specialist manages the billing processes specifically related to clinical research studies, ensuring accurate and compliant billing to sponsors, insurers, or third- party payers. The Research Billing Specialist is responsible for participating in the billing workflow process that ensures charges associated with NCH Research Institute clinical trials are billed to the appropriate responsible party, adhering to both federal and institutional compliance guidelines. This employee works closely with the NCHRI team and hospital and physician billing and coding staff to deliver timely and accurate processing of study-related charges.
ESSENTIAL DUTIES AND RESPONSIBILITIES
– Other duties may be assigned.
· Works closely with Coding, Revenue Cyle, Compliance, and Research Teams to deliver accurate, complete, and timely claims.
· Oversee and collaborates with the day-to-day clinical research billing and reimbursement activities.
· Maintains, reviews, and understands ICH-GCP guidelines and clinical research billing and reimbursement regulations. Collaborate with internal and external stakeholders to resolve billing and reimbursement issues.
· Provide exceptional customer service by responding to inquiries related to billing and reimbursement.
· Reviews all charges for NCHRI clinical trial-related services, communicating relatedness to a research trial and identifying the correct Payer according to research protocols and contract agreements.
· Works closely with members of the research team to determine which services are covered by the clinical trial sponsor and which are standard of care, ensuring accurate billing to appropriate party.
· Continues to keep up to date with relevant federal regulations, clinical trial guidelines and institutional policies supported by information and education provided by the NCH Billing and Coding Team.
· Analyze billing/reimbursement data to identify trends, generate reports, and contribute to process improvements.
· Diligently works/reviews billing reports and work queues to decrease bill hold accounts.
· Assist with patient questions regarding research-related bills.
· Conducts internal audits to ensure compliance in:
o Accurate Billing: Processing and verifying correct research study charges, including lab tests, procedures, and treatments.
o Compliance: Ensuring adherence to billing policies, coverage determinations, regulations, and guidelines through education and updates from NCH Billing and Coding Department.
o Liaison: Serving as a point of contact for research coordinators and payers, addressing questions and resolving concerns.
o Training and Support: Providing ongoing training and support to staff on complex research billing workflows.
o Data Entry and Filing: Performing general administrative duties related to research billing.
· Reviews the EPIC work queue daily of all NCHRI research accounts, evaluating and processing all assigned patient accounts for relatedness to Research and payee source in a timely and accurate manner.
· Reviews clinical trial protocols to determine billing requirements and ensure appropriate charge segregation.
· Assist in the development and maintenance of coverage guide and billing grids in collaboration with research, finance, and study teams; provides specific reimbursement guides provided by study sponsors to billing and coding teams.
· Identify and resolve discrepancies between clinical trial activities and billing records to prevent erroneous or duplicate charges.
· Works comfortably with established research earning and billing software foundations and serves as a resource for research related learning and compliance.
· Communicate with sponsors, CROs, and internal departments regarding billing inquiries and corrections.
· Participate in audits and corrective action plans related to research billing compliance.
· Stays updated on changes in research-related billing compliance regulations and educate team members as needed.
· Represents NCH Research Institute in committees and external organizations in a professional, knowledgeable, and cooperative manner at all times, collaborating effectively with multidisciplinary teams.
EDUCATION, EXPERIENCE AND QUALIFICATIONS
· Minimum High School or GED required. Associate or Bachelor’s degree in Healthcare Administration, Business, or related field preferred.
· Minimum of 2 years in an academic clinical research environment preferred
· Understanding of medical billing practices, coding and compliance. Knowledge of coding (CPT, HCPCS, ICD-10) and coverage analysis principles is preferred.
· Familiarity with billing software and electronic health record systems, specifically EPIC.
· Familiarity with Clinical Trial management systems is a plus.
· Ability to communicate effectively with researchers, patients, and payers.
· Ability to work with accuracy and attention to detail in a fast-paced environment.
· Strong analytical and organizational skills.
· Ability to collaborate effectively with multidisciplinary team.