ClinicalTrialCoverageAnalyst

We are so glad you are interested in joining Sutter Health! **Organization:** SHSO-Sutter Health System Office-Valley **Position Overview:** Responsible for determining if a study is a qualifying clinical trial, and performing the initial coverage analysis review by analyzing individual research protocol clinical services to assure federally compliant billing and reimbursement. Ensuring complete submission of documents required to conduct a coverage analysis and activate a study and submitting notification of participation letter to Noridian (MAC) when needed. Determining and documenting billing support for clinical items by reviewing the protocol, investigator brochures, sponsor budget, sponsor proposed contract, and consent template, the evidence of medical necessity justifications, and appropriate payers of protocol-specific services and federally required research-related claims modifications for service payment by insurance. Conducting the final review and analysis of study documents to assure all study-related documents are harmonized. Interpreting Medicare/Medicaid coverage decisions, national guidelines as they apply to specific clinical trial medical items and services. Supporting Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) billing determinations of clinical trial items and services and applying all applicable local coverage decisions, national and local coverage determinations, and third-party payer rules for clinical trial coverage analyses. Interfacing with various Sutter Health research affiliates, administrative staff, principal investigators, essential partners, and clinical trial sponsors regarding reimbursement for research services. Implementing an integrated support function that standardizes the administrative and financial support functions of clinical trial billing compliance thereby improving service to the Sutter Health research community and providing an increased level of research compliance. **Job