Regulatory Oversight Specialist – Research Perform prospective reviews of research related/clinical trial processes that directly impact the integrity of billing to federal/non-federal sponsors and claims billed to governmental and non-governmental payors. Assists with audits of information related to study protocols/grid development, Medicare Coverage Analysis audits, and audits of charge segregation functions impacting billed charges to federal grants, sponsored contracts and insurance payors. Special projects may arise from requests made by senior revenue cycle leadership, Office of Legal Counsel, Office of Compliance and Corporate Integrity and Research Executive Administration. Should be able to initiate and plan projects with a high degree of autonomy and provide summaries of issues and corrective actions to various levels of executive leadership. Analysis of impacts to insurance and patient billing will be audited as part of project assignments. The non-supervisory position reports to the AVP of Finance, VP of Revenue and Reimbursement, or other designated finance executive within the Office of Finance/Revenue Cycle. Lead prospective and retrospective reviews of study protocols, billing grid development and research charge segregation functions. Analyze compliance with CMS regulations for billing of research studies and clinical registries by auditing Medicare Coverage Analysis, Coverage with Evidence Development (CED) guidelines, medical documentation in EPIC, and insurance and patient billing and collection transactions. Perform special projects related to compliance matters as requested by Office of Compliance and Corporate Integrity and/or Office of Legal Counsel. Analyze data files in Excel to evaluate compliance with criteria under review and document findings and key recommendations in a clear and concise manner. Lead complex financial, operational, reimbursement, and business analyses. Interpret and communicate analytical findings and recommendations to leadership. Present key findings and recommendations to executive level management. Support legal, compliance and research administration leadership, and finance committee reporting requirements. Lead initiatives to improve CMS regulatory oversight monitoring and control processes. Evaluate clinical trials management systems, workflows, and reporting tools and recommend enhancements. Promote standardization and best practices across enterprise financial processes. Identify opportunities to leverage technology, automation, and analytics to improve effectiveness. Assist in establishing work priorities, project objectives, and departmental goals related to the Regulatory Oversight function. Foster a culture of accountability, collaboration, innovation, and continuous improvement. Maintain updated knowledge of federal and state regulatory changes pertaining to areas in scope of functional oversight. Contribute to major finance department projects and organizational priorities. Perform other duties as assigned. Bachelor's Degree and 10 years of relevant work experience preferably in Research Administration, Clinical Trials Management, Revenue Cycle, Consulting or Auditing in a Large Academic Medical Center. CHRC (Certification in Healthcare Research Compliance) and/or CHC (Certified in Healthcare Compliance) preferred. Familiarity with OnCore Clinical Trials Management System strongly preferred.
