Description:

About the Role

This role will support research financial processes across Loyola Medicine service lines. This role is critical to ensuring accurate charge segregation, maintaining research billing compliance, managing Medicare Coverage Analyses (MCA), and resolving billing disputes.

What You’ll Do

• Perform charge segregation and corrections in alignment with approved Medicare Coverage Analyses (MCA)
• Manage research financial workflows, including statement review and resolution of disputed charges
• Identify and escalate high-risk studies and potential audit concerns
• Independently review, update, and amend Medicare Coverage Analyses based on clinical trial documentation
• Maintain and update research fee schedules
• Assist in identifying and validating CPT codes for research-related procedures and services
• Collaborate with cross-functional teams (e.g., Revenue Integrity, Compliance) to ensure compliant billing practices
• Provide back-up support to the Clinical Research Business Analyst
• Ensure adherence to federal, state, and local regulations, as well as Trinity Health policies, Code of Conduct, and compliance standards
• Demonstrate Trinity Health Mission, Values, Vision, and guiding behaviors in daily work

What You’ll Need

Required Qualifications

• 2–4 years of experience in research, medical billing, or coding
• Strong knowledge of Medicare Coverage Analyses, with the ability to interpret and apply clinical trial documentation
• Experience working with Epic systems, including reviewing and analyzing charge reports
• Solid understanding of clinical research billing regulations and workflows
• Strong analytical skills with high attention to detail
• Ability to work independently, manage competing deadlines, and prioritize workload effectively
• Excellent communication skills with the ability to work across multiple departments

Preferred Qualifications

• Bachelor’s degree in Finance, Healthcare Administration, or a related field (experience may substitute for education)
• Formal training in Medicare Coverage Analysis and/or clinical trial billing compliance
• Certified Professional Coder (CPC – AAPC)
• SOCRA or ACRP certification