This position provides pre-initiation research study evaluation including cost, coverage, and overall financial benefit analysis. Ensures analytical evaluations provide relevant and complete measures of cost, revenue, and billing projections and processing. Audits administrative aspects of ongoing research to ensure effective coordination of payments from sponsors. Ensures regulatory compliance and financial coverage. Develops and maintains effective project relationships. Translates medical service priorities into effective research development activities and support allocations to ensure research leads to desired outcomes consistent with organizational goals.
Completes Cost and Coverage Analysis. Completes CCA for all BH research studies utilizing clinical skills, good clinical practices and knowledge of research and government regulations to evaluate each new study and determine appropriate coverage and billing requirements. If required, also completes a Medicare Coverage Analysis. Serves as a knowledgeable consultant to guide other personnel on the determinations of what patient care items and services are considered standard of care. Creates study budget for any and all research activity occurring within a BH facility to accurately determine relevant costs associated with all research activity. Negotiates study budget, with study Sponsor integrating Medicare Coverage rules and allowances into contract to ensure proper reimbursement and study billing requirements are met. Assesses study financial risk/benefit ratio.
Ensures regulatory compliance and financial coverage. Ensures compliance with required federal, state, funding source, and other applicable governing entities regarding regulations, laws, and statutes governing the scope of research activity. Works collaboratively with staff(s) and various other departments to obtain names of human subjects to ensure that research related charges are billed appropriately. Acts as a liaison between finance departments, patient financial services, facility research directors and system reimbursement services for the purpose of communicating information regarding the National Coverage Decision for clinical trials and other federal research regulations. Serves as a resource and provides leadership assistance for research participants; asks questions regarding financial coverage issues to ensure service excellence.
Performs audits and monitors reimbursements. Assists in monitoring patient reimbursement activity and will bill the sponsor (when appropriate) if denied from insurance company. Performs for cause and random patient account audits to ensure compliance and review of financial status in order to secure accounts receivable.
Develops and maintains effective project relationships. Coordinates closely with Banner Research staff in the study approval process; meets project timelines and department goals of optimal clinical, operational, financial and satisfaction outcomes. Interacts with sponsors, physicians, colleagues, facility administrators, facility CFOs and patient financial services to ensure effective communication and project coordination. Translates medical service priorities into effective research development activities and support allocations to ensure research leads to desired outcomes consistent with organizational goals. Leads and administers research projects by promoting research and collegiality between physician investigators, staff, facility administrators, and department heads. Leads, facilitates and or participates in task forces or councils to plan, implement and coordinate programs and/or activities for the organization.
Bachelors degree in business or healthcare related field or an equivalent combination of education and experience; may consider RN with background in managed care or third party payor environment.
Three to 5 years of experience in a patient financial position including substantial exposure to clinical and/or grant administration environment, utilization/care management or research role.Strong knowledge and understanding of reimbursement methodologies Proven analytical and modeling skills. Working knowledge of computer spreadsheets and other computer applications.
Additional related education and/or experience preferred.
Internal Number: 214090
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.