Clin Trials Rsch Coverage Analyst

Job Description Location: Chicago, Illinois Business Unit: Rush Medical Center Hospital: Rush University Medical Center Department: Research Billing Support Work Type: Full Time (Total FTE between 0.9 and 1.0) Shift: Shift 1 Work Schedule: 8 Hr (8:30:00 AM - 5:00:00 PM) Rush offers exceptional rewards and benefits learn more at our Rush benefits page ( Pay Range: $29.36 - $47.79 per hour Rush salaries are determined by many factors including, but not limited to, education, job-related experience and skills, as well as internal equity and industry specific market data. The pay range for each role reflects Rushu2019s anticipated wage or salary reasonably expected to be offered for the position. Offers may vary depending on the circumstances of each case. Summary: Reporting to the Director/Manager of Clinical Trials Research Revenue Cycle, this position will create coverage analyses in accordance with Medicare's Clinical Trial Policy (NCD 310.1) and assist research staff within the clinical departments with the interpretation of related guidance and their effect on research billing processes. The analyst will provide high-level professional support in the growing efforts to conduct prospective Medicare Coverage Analysis for all clinical research studies. Exemplifies the Rush mission, vision and values and acts in accordance with Rush policies and procedures. Exemplifies the Rush mission, vision and values and acts in accordance with Rush policies and procedures. Other information: Experience/Qualifications/ Competencies: u2022 Bachelor's Degree in a health-related discipline, e.g. pharmacology, nursing, biology (Four years of additional work experience in lieu of bachelor's experience). u2022 One to five years of coding experience u2022 AAPC or AHIMA certification in coding within one year of hire with experience in research medical billing and coding. Certifications may include Certified Professional Coder (CPC), Certified Coding Specialist (CCS) and Certified Medical Coder (CMC), and any other specialized coding certification approved by the two main governing bodies. u2022 Proficiency with medical terminology as well as medical research billing language. Must demonstrate a thorough knowledge of the three code sets that are currently in use: Current Procedural Terminology (CPT), ICD-10-CM, and Healthcare Common Procedure Coding System (HCPCS) Level II. u2022 Excellent written and oral communication skills. u2022 Strong investigative skills. u2022 Proficiency with MS Excel tables, formatting and basic calculations. u2022 Demonstrated resourcefulness and attention to detail. u2022 Able to work in a team environment and maintain a positive outlook. u2022 Able to learn and apply technical knowledge in the areas of clinical research, medical coding and revenue cycle in a consultative manner. u2022 Excellent verbal and written communication skills due to direct interaction with senior management. u2022 Strong time management and organizational skills with the ability to effectively multi-task and meet deadlines. u2022 Strong problem solving and financial analytical skills. High degree of accuracy for analyses and processes. u2022 Must have a strong customer service focus. Preferred Job Qualifications: u2022 Familiarity with different types of clinical research and the drug development process. u2022 Understanding of FDA regulations related to clinical trials involving lnvestigational New Drugs (INDs) and/or lnvestigational Device Exemptions (IDEs). u2022 Knowledge of Medicare coverage decisions, benefit policy manuals and billing processes. u2022 Previous experience in Research Billing, Budgeting/ budgeting analysis for Research Clinical Trials, Coverage Analysis, or other Research Finance background. Responsibilities: u2022 Maintain a detailed understanding of Medicare's Clinical Trial Policy (NCD 310.1) and related guidance documents. u2022 Generate detailed and accurate coverage analyses with budget overlay in a timely manner. u2022 Review clinical trial protocols and related regulatory documents to prepare a billing plan for all medical procedures and services required in a clinical research project. u2022 Review clinical research protocols and determine which procedures are routine, and therefore billable to Medicare and other third-party payers based on CMS policy and National and Local Coverage Determinations, as well as professional practice guidelines. Extensive independent research to identify applicable practice guidelines will be required. u2022 Review patient informed consent forms to ensure that the document accurately informs patients which procedures will be billed to their insurance vs. those that will be covered by the study budget, in accordance with the MCA. u2022 Ensure consistency of the payment terms in the coverage analysis with the protocol, the informed consent form template, the budget and the contract payment terms. u2022 Completely and effectively document MCA determinations to support the decision-making process. u2022 Screen research protocols to determine whether a formal Medicare Coverage Analysis (MCA) is required. u2022 Collaborate with investigators to determine whether each study is a qualifying clinical trial under CMS Clinical Trial policy. u2022 Coordinate with IRB staff and the investigator if the IRB raises issues regarding the determinations of the Medicare Coverage Analysis and/or consent form language. u2022 Collaborate and communicate effectively with investigators and research staff, Patient Financial Services, the IRB, and Research Compliance with respect to Medicare Coverage Analysis issues and determinations. u2022 Keep current with FDA and Medicare regulations and state laws applicable to clinical research billing. u2022 Conduct special department related projects as they are assigned. u2022 Prepare applications for approval of billing for investigational devices. u2022 Serve as a resource for protocol and budget development and overlay. u2022 Provide staffing and supply/service consumption patterns, the methods used to estimate/calculate (including escalation or inflation factors) and other details such as lists of items that make up the total costs for a category. The budget justification should address each of major cost categories (salaries, fringe benefits, equipment, travel, supplies, other direct costs and indirect costs), as well as any additional categories required by the sponsor as related to research budget overlay. u2022 Organize the budget justification listing items in the same order and format as the sponsoru2019s budget categories. u2022 Check validity of all draft and finalized documents prior to calendar release. The Budget narrative must match the budget in terms of dollar amounts and language. u2022 Explain why items are essential in relation to the aims and methodology of the project as well as meeting the goals of the project. u2022 Understand and describe the line items to clinical study team as necessary. Do not merely restate the proposed expenditure. u2022 Provide detail that is sufficient to justify the rationale for the budget overlay. Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics. Position Clin Trials Rsch Coverage Analyst Location US:IL:Chicago Req ID 19972

Created: 2026-01-23