What are the responsibilities and job description for the Research Billing Analyst position at Advocate Aurora?
Major Responsibilities:
Licensure, Registration, and/or Certification Required:
Education Required:
Experience Required:
Knowledge, Skills & Abilities Required:
Physical Requirements and Working Conditions:
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
- Reviews clinical research protocols and determines whether the trial meets the necessary criteria for billing of routine costs to the patient/insurance.
- With assistance, analyzes and interprets governmental and commercial payer guidelines in conjunction with the study documentation to determine the appropriate payer for each test/procedure required by the research protocol. Applies such interpretation in order to prepare and finalize the electronic study billing grid prior to enrolling patients into the study. Maintains up-to-date knowledge on Medicare, Medicaid, and other regulatory requirements pertaining to accepted coverage, billing, and reimbursement policies and standards.
- Reviews study documentation, medical records, and study billing grids to appropriately segregate research charges from charges billable to the patient/insurance once the patient visit has been completed and charges appear in the electronic health record billing system.
- Assists study budget analysts with preparation of front-end documentation for compliant billing and accurate budgeting of research protocols. Reviews protocol amendments to determine whether changes to the study billing grids are necessary.
- Performs quality assurance reviews on billing grids prepared by other billing analysts to ensure charge segregation decisions are appropriate.
- Communicates relevant governmental and commercial policy rules to study teams and appropriate service lines for reimbursement of coverage for services on research patients. Provides education, feedback, and clinical expertise to study teams and clinical departments to ensure consistency and accuracy in research charging and billing process.
- Collaborates with appropriate personnel to identify and remedy issues with particular studies and/or patient bills. Incorporates knowledge gained from such activities to enhance front-end processes.
- Assists in the development of departmental tools and templates as well as standard operating procedures. Assists with other projects as requested.
Licensure, Registration, and/or Certification Required:
- None Required.
Education Required:
- Bachelor's Degree in Nursing or related field.
Experience Required:
- Typically requires 3 years of experience in healthcare.
Knowledge, Skills & Abilities Required:
- Demonstrates knowledge of ICD and CPT coding systems, HCPCS, MS-DRGs and APC.
- Knowledge of Medicare, Medicaid and commercial
- payer coding/billing guidelines
- Knowledge and understanding of anatomy, physiology, medical terminology, and pathophysiology (disease process, surgical terminology, and pharmacology.)
- Knowledge of pharmacology indications for drug usage and related adverse reactions
- Knowledge of optimization of technology including how to navigate the electronic health information record and in health information management and billing systems.
- Experience with Microsoft Office.
- Excellent communication and reading comprehension skills
- Excellent critical thinking and analytical skills, with a high attention to detail
- Ability to work independently and exercise independent judgment and decision making
- Ability to work under multiple daily deadlines while working in fast-paced environment
- Demonstrated ability to work well with other professionals in a collaborative and positive manner
- Excellent organization, prioritization, and problem solving skills
- Capable of taking a firm stance on issues of importance without giving in to pressures
- Experience in project management with a high degree of accountability to project stakeholders.
Physical Requirements and Working Conditions:
- Position may require travel which may result in exposure to road and weather hazards.
- Exposed to normal office environment.
- Operates all equipment necessary to perform the job.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
Salary : $1 - $1,000,000
Analyst I - Billing
AssuranceSD -
Wauwatosa, WI
Research Management System Analyst
Advocate Aurora Health -
Milwaukee, WI
Research Management System Analyst
Advocate Aurora -
Milwaukee, WI
