The University of New Mexico Comprehensive Cancer Center (UNMCCC) Clinical Trials Financial Analyst (Medicare Coverage Analyst) is responsible for reviewing clinical research protocols, informed consent forms, clinical trial agreements, and other relevant study-related documents to create a Medicare Coverage Analysis.
The position determines whether the proposed clinical research study is a qualifying clinical trial as defined by the Medicare Clinical Trial Policy (NCD 310.1), while also being cognizant of Medicare/Medicaid Benefit Policies, third-party Medical Benefit Policies, relevant National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), Code of Federal Regulations (CFRs), state laws, professional practice guidelines. The position will be responsible for creating a billing justification plan or 'coverage analyses' to reflect which medical procedures and services are 'Routine Cost' and billable to patient insurance and which ones are research and paid by the study sponsor for investigator-initiated, industry-sponsored, and non-industry sponsored clinical trials across multiple clinical working groups. The position will disseminate the coverage analysis, the related guidance and their effect on research billing processes to all appropriate parties, to include, Principal Investigator, research team, affiliate sites, and other research and administrative staff. Assist with the development of institutional policies and procedures pertaining to clinical research budgeting and billing, including the MCA process. Other duties may be assigned as required.
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The University of New Mexico Comprehensive Cancer Center is the Official Cancer Center of New Mexico and the only National Cancer Institute-designated Cancer Center in a 500-mile radius. Its more than 136 board-certified oncology specialty physicians include cancer surgeons in every specialty (abdominal, thoracic, bone and soft tissue, neurosurgery, genitourinary, gynecology, and head and neck cancers), adult and pediatric hematologists/medical oncologists, gynecologic oncologists, and radiation oncologists. They, along with more than 600 other cancer healthcare professionals (nurses, pharmacists, nutritionists, navigators, psychologists and social workers), provide treatment to 65% of New Mexico’s cancer patients from all across the state and partner with community health systems statewide to provide cancer care closer to home. They treated almost 15,000 patients in more than 100,000 ambulatory clinic visits in addition to in-patient hospitalizations at UNM Hospital. A total of nearly 1,855 patients participated in cancer clinical trials testing new cancer treatments that include tests of novel cancer prevention strategies and cancer genome sequencing. The more than 123 cancer research scientists affiliated with the UNMCCC were awarded $38.2 million in federal and private grants and contracts for cancer research projects. Since 2015, they have published nearly 1000 manuscripts, and promoting economic development, they filed 136 new patents and launched 10 new biotechnology start-up companies. Finally, the physicians, scientists and staff have provided education and training experiences to more than 500 high school, undergraduate, graduate, and postdoctoral fellowship students in cancer research and cancer health care delivery. Learn more at http://cancer.unm.edu.
Conditions of Employment
Minimum Qualifications
Bachelor's degree; at least 3 years of experience directly related to the duties and responsibilities specified.
Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.
Preferred Qualifications
a. Experience in healthcare finance, clinical trial budgeting, and operations analysis
b. Experience and knowledge of clinical trial protocols
c. Demonstrated experience in Clinical Research Billing and Billing Compliance
d. A demonstrated understanding of Research Billing Compliance including National and Local Coverage Determination for coverage of routine costs and the CMS Clinical Research Policy as well as professional practice guidelines.
e. A demonstrated knowledge of regulatory, financial and administrative requirements of Medicare and third-party billing of clinical trials. Extensive review of patient informed consent forms to ensure that the document accurately reflects which procedures will be billed to insurance vs. those that will be covered by the study budget in accordance with the MCA.
f. Ensure consistency of the payment terms in the coverage analysis with the protocol, the informed consent template, the budget and the contract payment terms.
g. Keep current with the FDA and Medicare regulations and state laws applicable to research billing.
h. Provide staffing and supply/service consumption patterns, the methods used to calculate and other details such as lists of items that make up the total cost of a category.
i. Certification in coding, Procedural Terminology, and Healthcare Common Procedure Coding system is preferred.
j. Advanced knowledge of Microsoft Excel
Additional Requirements
Finalists should be prepared to provide official educational transcripts if selected for hire.
Applicants must provide names of 3 professional references that the hiring official can contact.
Campus Health Sciences Center (HSC) - Albuquerque, NM
Department CRTC Clinic Rsrch Data Management (099L)
Employment Type Staff
Staff Type Regular - Full-Time
Term End Date
Status Exempt
Pay $4,688.67 - $6,709.73
Benefits Eligible This is a benefits eligible position. The University of New Mexico provides a comprehensive package of benefits including medical, dental, vision, and life insurance. In addition, UNM offers educational benefits through the tuition remission and dependent education programs. See the Benefits home page for a more information.