**Req Number** 149301 Job Description Supports clinical research billing compliance and all aspects of clinical trials billing reviews. Provides daily coordination, monitoring and management of accounts for clinical trials. Directs and monitors all research account activity, provides administrative support and assists with establishing research study records in the electronic health record. Ensures all facility charges and professional fees from clinical research protocol visits are consistently segregated and billed to the appropriate payor and/or sponsor and properly reimbursed to avoid denials and mitigating billing risks. Job Responsibility 1.Follows all clinical trial subject accounts to assure timely review, processing, payment, and accurate reimbursement. 2.Performs detailed analysis of clinical trial accounts and agreements using multiple resources and systems including EPIC for decision making of whether charges are billable to insurance or billable to the study. 3.Responsible for the contacting third-party payers to verify timely billing requirements. Add and update clinical trial information on patient accounts. 4.Effectively utilizes reports, and special projects to resolve claim rejections on accounts as well as identify problem accounts. Identifies and takes action needed to resolve accounts. Resolves problem accounts using all available resources, both internally and externally, as evidenced by observation, documentation, and feedback. Respects confidentiality of patient information and uses discretion when answering questions. 5.Assists in performing routine billing functions/job duties accurately and efficiently. Assists in processing all inpatient, outpatient and reoccurring accounts for all payers and all facilities, in an accurate, compliant, and timely manner by investigating billing errors. 6.Performs remediation of charge errors discovered during review EPIC review. 7.Determines and adds appropriate billing modifiers and other CMS (Centers for Medicare & Medicaid Services) requirements for billing research-related charges to subjects insurance. 8.Knowledgeable about CMS and Fiscal Intermediary medical necessity guidelines and their impact on billing and reimbursement in clinical research. 9.Audit and review accounts to ensure accuracy; investigate and correct errors, follow-up on missing account information, and resolve past due accounts. 10.Works with clinical research, coding, billing, compliance, and other internal or potentially external professionals to reconcile any discrepancies in data entered in the system. 11.Prepares statements and invoices based on services rendered every month; maintains accounts receivable by processing sponsor payments, site payments and accounts payable reports; invoice matching, data entry and reconciliation of accounts. 12.Posts payments and check deposits. 13.The Clinical Research Representative ensures that all charges for facility and professional fees arising from clinical research protocol visits and services are consistently segregated and billed to the appropriate payer and/or sponsor, submitted with proper codes, IDE# if applicable, modifiers and NCT number, and properly reimbursed, avoiding efforts in managing denials and mitigating risks of double-billing to both a study sponsor and an insurer. 14.Reviews research informed consent to understand the charges to patients, the Medicare coverage analysis, the billing grid, and the National Coverage Decision (NCD) for clinical trials. 15.Performs related duties as required. Job Qualification * Bachelor's Degree required, or equivalent combination of education and related experience. * 1-3 years of relevant experience, required. *Additional Salary Detail The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity). The salary range for this position is $58,540-$92,650/year It is Northwell Health’s policy to provide equal employment opportunity and treat all applicants and employees equally regardless of their age, race, creed/religion, color, national origin, immigration status or citizenship status, sexual orientation, military or veteran status, sex/gender, gender identity, gender expression, disability, pregnancy, genetic information or genetic predisposition or carrier status, marital or familial status, partnership status, victim of domestic violence, sexual or other reproductive health decisions, or other characteristics protected by applicable law.