Easter Seals Jobs

Organization:

SHSO-Sutter Health System Office-Valley

Position Overview:

Responsible for determining if a study is a qualifying clinical trial, and performing the initial coverage analysis review by analyzing individual research protocol clinical services to assure federally compliant billing and reimbursement. Ensuring complete submission of documents required to conduct a coverage analysis and activate a study and submitting notification of participation letter to Noridian (MAC) when needed. Determining and documenting billing support for clinical items by reviewing the protocol, investigator brochures, sponsor budget, sponsor proposed contract, and consent template, the evidence of medical necessity justifications, and appropriate payers of protocol-specific services and federally required research-related claims modifications for service payment by insurance. Conducting the final review and analysis of study documents to assure all study-related documents are harmonized. Interpreting Medicare/Medicaid coverage decisions, national guidelines as they apply to specific clinical trial medical items and services. Supporting Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) billing determinations of clinical trial items and services and applying all applicable local coverage decisions, national and local coverage determinations, and third-party payer rules for clinical trial coverage analyses. Interfacing with various Sutter Health research affiliates, administrative staff, principal investigators, essential partners, and clinical trial sponsors regarding reimbursement for research services. Implementing an integrated support function that standardizes the administrative and financial support functions of clinical trial billing compliance thereby improving service to the Sutter Health research community and providing an increased level of research compliance.

Job Description :

EDUCATION:

• Bachelor's or equivalent education/experience

TYPICAL EXPERIENCE:

• 5 years recent relevant experience

SKILLS AND KNOWLEDGE :

• Demonstrated knowledge of clinical research concepts, good clinical practices and regulatory compliance.

• Knowledge of Medicare benefit categories, statutory exclusions, and national and local coverage determination and of national medical practice guidelines, Food and Drug Administration investigational drug and device research.

• Knowledge of medical coding, protocol visit span allowances, protocol-specified clinical services, and basic research study demographics of clinical research financial activities and documentation required before study initiation, including research protocol, internal budget, sponsor contract and budget, and consent template.

• Demonstrated written, oral, electronic communication, presentation and interpersonal skills.

• Ability to use multiple technical systems as intended; ability to collaborate across revenue cycle, compliance, and research operations teams; and attention to detail.

• Analytical and computer skills, including proficiency in Microsoft Word, Outlook, and Excel.

• Ability to work independently and to accept responsibility for complex and sensitive decision making as it relates to the position.

• Outstanding organization skills to manage many competing timetables and responsibilities.

• Demonstrated leadership skills, including team building, and coaching/mentoring with the ability to motivate and engage others.

• Ability to build and establish effective working partnership with employees, peers and/or leaders to achieve business objectives.

• Verbal and written communication, and interpersonal skills.

• Organizational and time management skills, with the ability to prioritize multiple projects while delivering quality service and achieving business results.

• Demonstrates tactical and analytical thinking and planning skills, and is able to develop plan to accomplish objectives, identify obstacles and resolve operational issues.

• Demonstrated skill in communicating and collaborating with Sutter Health essential partners (Legal Services, ECS, SHIRB) and research institute personnel.

Job Shift :

Days

Schedule :

Full Time

Shift Hours:

8

Days of the Week:

Friday, Monday, Thursday, Tuesday, Wednesday

Weekend Requirements:

None

Benefits:

Yes

Unions:

No

This position is work from home eligible.

Position Status:

Exempt

Weekly Hours:

40

Employee Status:

Regular

Number of Openings:

1

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $44.28 to $66.42 / hour. Colorado, Florida, Georgia, Illinois, Michigan, Nevada, North Carolina, Oregon, Pennsylvania, Texas Pay Range is $38.69 to $58.03 / hour. Arizona, Arkansas, Idaho, Louisiana, Missouri, Montana, South Carolina, Tennessee, Utah Pay Range is $34.39 to $51.58 / hour.

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.