Allegheny Health Network
Job Description :
Responsible for the Medicare Coverage Analysis (MCA) for sponsored projects within WPAHS, budget development and contract negotiations.
- Responsible for supporting management in the completion and tracking of MCA's. Reviews protocols, informed consent forms, contracts, Notices of Grant Award, FDA letters in the Conduct of an MCA. A key responsibility is the creation, revision and management of spreadsheets related to Medicare coverage analysis and compliance with Medicare rules and regulations. (60%)
- Use MCA analysis to develop study budgets and negotiate contracts with sponsors to ensure maximum reimbursements to AHN. (25%)
- Meet with research teams (Principal Investigators and study coordinators) to review MCA analysis, study budgets and contracts. (5%)
- Coordinate with other service departments to determine appropriate service/cpt codes for use in the MCA billing grid. (5%)
- Work closely with the clinical trial billing team to ensure that MCA is accurate, and make modifications if needed. (5%)
- Performs other duties as assigned or required.
- Two years’ experience within a health care or clinical setting
- Advanced experience using spreadsheet and word processing applications
- Knowledge of regulations regarding the protection of human subjects in clinical research
- Knowledge of medical terminology
- Bachelor’s degree in Business, Finance or related field or equivalent experience
- Experience as a Research Coordinator, Clinical Coordinator, Clinical Research Associate, Coding Professional or related field
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
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