Clinical Research Billing Reviewer I - Office of Clinical Research (CTSI)

The Clinical Research Billing Reviewer I is a position that resides in the Office of Clinical Research (OCR) within Wake Forest University School of Medicine (WFUSM) Clinical & Translational Science Institute (CTSI) team. Under the direction of the Manager, Clinical Research Billing Review the position is an entry-level performer of charge capture and claim resolution in Epic (electronic health record and patient billing system) for clinical research studies across all regions of the Atrium Enterprise. The position is responsible for performing line-item charge review of research patient encounters in the Atrium Health charge capture system, EPIC. The position will assure the accuracy and completeness of all assigned charges linked to research in EPIC and captured in EPIC for study sponsor or insurance/patient billing of inpatient and outpatient hospital services for research participants. Clinical research billing reviewer activities include but are not limited to the review and allocation of research charges in EPIC.

EDUCATION/EXPERIENCE: 

• High School Diploma or GED required; Associates Degree preferred.  
• Minimum of 1-year related coding/reimbursement experience preferred. 
• Medical terminology, knowledge of accounts payable and receivable processes preferred. 
• Minimum of 1-year business office experience in a healthcare environment or Research Office experience preferred.

LICENSURE, CERTIFICATION, and/or REGISTRATION: 

• CPC or RHIT certification preferred.

ESSENTIAL FUNCTIONS:

1. Performs review of all technical and professional charges generated from EPIC and any ancillary subsystems for allocation to the research study account, insurance claim and/or patient statement to verify the accuracy of charges as they compare to the research billing intention/plan outlined in the protocol Billing Grid.
2. Performs remediation of charge errors discovered during EPIC review.
3. Identifies appropriate use of billing modifiers and other CMS requirements for billing research-related charges to federal and non-federal payors.
4. Verifies and resolves discrepancies by utilizing the tools and resources available, e.g., EPIC billing system, OnCore (clinical trial management system), medical record documentation, Charge Master data, Patient Accounting/VMG Business Offices and/or contacting study personnel in the appropriate internal department.
5. Remains knowledgeable about CMS and Fiscal Intermediary medical necessity guidelines and their impact on billing and reimbursement in clinical research.
6. Collaborates with the clinical research department administrators and study coordinators in the development and implementation of educational activities related to charge capture improvement projects.
7. Supply all missing information and correct inaccurate data as needed.
8. Processes charge related corrections/additions/removals in EPIC for both the hospital and physician billing to ensure organizational compliance with all state and federal regulations.
9. Calculates and facilitates the refunding of inappropriate reimbursement in collaboration with WFBMC Financial Services. Responsible for the movement of funds and correction of fees in EPIC.
10. Follows established hospital and physician departmental guidelines and state and federal regulations to assure the most productive and compliant outcome when processing charge related corrections.
11. Perform specialized duties involved in the preparation and processing of particularly complex charge issues.
12. Audit and review accounts to ensure accuracy; investigate and correct errors, follow-up on missing account information, and resolve past due accounts.
13. Identify insurance issues that need to be forwarded and addressed by the appropriate insurance teams.  Report issues to the appropriate supervisor as needed.
14. Prioritizes job tasks; demonstrates willingness to assist Manager/Director in the completion of special projects and daily task to support the Department’s productivity and efficiency.
15. Demonstrates responsibility for personal development by participating in continuing education offerings.
16. Performs other related duties, as assigned.

SKILLS/QUALIFICATIONS:

• Excellent oral and written communication skills. 
• Excellent phone etiquette and internal/external customer service skills, required.
• Strong interpersonal skills and attention to detail.
• Experience with computerized databases (e.g., Microsoft Excel), word processing (e.g., Microsoft Word), and presentation software (e.g., Microsoft PowerPoint).
• Demonstrates ability to work independently.

WORK ENVIRONMENT:

• Clean, comfortable, well-lit, office environment.
• Work from home

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