The Medicare Coverage Analyst (MCA) is responsible for reviewing clinical research protocols, Informed Consent Forms, Clinical Trial Agreements, and other relevant study-related documents to create a coverage analysis/billing guide. The coverage analysis indicates which medical procedures/services maybe 'Routine Cost' and billable to patient insurance and which should be billed to the study sponsor.
The Medicare Coverage Analyst determines whether proposed clinical research studies are a Qualifying Clinical Trial as defined by the Medicare Clinical Trial Policy (NCD 310.1) and designates medical procedures/services based on relevant regulations and determinations.
The Senior Medicare Coverage Analyst applies subject matter expertise to complex protocols and mentors/trains junior team member.
Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS and related diseases. We strive to create an inclusive, diverse, and equitable environment where we provide compassionate and comprehensive care to patients of all backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we educate tomorrow's physician/researchers, and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.
Responsibilities Mentors and trains junior MCA staff, provides second-level review of junior staff determinationsCreates coverage analysis grids for complex protocolsServes as National and Local Coverage Determination (LCD and NCD) subject matter expert – disseminating changes to Medicare payor policy to other members of the MCA teamTriages and prioritizes coverage analysis workflow based on institutional need across disease centers – communicates MCA execution timelines to study teams and external stakeholdersServes as the primary point of contact for urgent protocol amendments with budgetary and MCA impact, prioritizes and executes in narrow timelinesIndependently interfaces with sponsors and sponsor representatives to resolve discrepancies in specific protocol assessmentsInterfaces with study team and principal investigators prior to protocol submission to assist with MCA determinations/study design Qualifications Bachelor’s Degree or RN Credential required5 years of Medicare coverage analysis experience requiredExperience with research activity in an academic medical centerExperience working in clinical trials management system (CTMS)CPT/DRG Coding experience preferredUnderstanding of research activity in an academic medical center
KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:
Understanding of research activity in an academic medical centerKnowledge of billing compliance and Medicare regulations/policy, applicable federal, state, and local laws, rules, regulations and policies and institutional policies and standard operating proceduresKnowledge of clinical research budgeting and the clinical trial life cycle: study start-up through study closureKnowledge of clinical trials management system (CTMS)
At Dana-Farber Cancer Institute, we work every day to create an innovative, caring, and inclusive environment where every patient, family, and staff member feels they belong. As relentless as we are in our mission to reduce the burden of cancer for all, we are equally committed to diversifying our faculty and staff. Cancer knows no boundaries and when it comes to hiring the most dedicated and diverse professionals, neither do we. If working in this kind of organization inspires you, we encourage you to apply.
Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other characteristics protected by law.
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