Career Center
Minneapolis, Minnesota
Posted: 15-Apr-23
Location: Baltimore, Maryland
Salary: Open
Internal Number: 108696-en_US
We are seeking a Research Billing Compliance Analyst I who will Review clinical documentation, coding and hospital or professional fee claim or charge information in accordance with the Prospective Reimbursement Analysis (PRA) to determine if the items and services provided to patients enrolled in clinical research studies are to be billed to Medicare, other third-party payers or research study accounts. Using auditing and analysis techniques, determines the adequacy of medical record documentation, coding and billing across all clinical specialties. Adequately documents the determinations made to support billing decisions. Works in close collaboration with the Clinical Trials Office, Clinical Practice Associations Physicians Billing Service, and the Johns Hopkins Health
Systems Compliance and Patient Financial Services Offices.
Specific Duties & Responsibilities
- Using the PRA, various reports, information systems and clinical documentation, timely reviews hospital or professional fee charges in pre-billing review to determine if the charge is to be billed to a third-party payer or to the research study. Adequately documents the rationale to support billing decisions.
- Reviews charges in pre-bill for coding accuracy, compliance with teaching physician rules, proper documentation completion and practices, and other state, federal, reimbursement, and internal regulations.
- Reviews/adjudicates account and claim level work queues in Epic and works to release the accounts in those work queues accurately and timely.
- Analyzes billing, documentation, or coding patterns by a provider, division or department that poses a compliance risk and recommends solutions to address the problem(s).
- Using information derived from clinical documentation, identifies changes in a patient's status within a research study or the start of a new clinical study, so that the data base of patients on pre-billing review is accurately and timely maintained.
- Keeps current with third party regulations with emphasis on Medicare coverage and billing, research, and teaching physician regulations, Current Procedural Terminology, ICD-10-CM Coding, and hospital and professional fee billing requirements.
- Works with research staff and the Director of Research Compliance Operations to ensure that the Clinical Research Management System (CRMS) has the most updated and accurate information.
Scope of Responsibility
- Knows the formal and informal office goals, standards, policies and procedures including familiarity with sensitivity to the relationships with other departments within the School of Medicine, the Clinical Trials Office, Clinical Practice Association and The Johns Hopkins Health System.
Decision Making
- On a regular basis, exercises administrative judgement and assumes responsibility for decisions, consequences, and results having an impact on people, costs, and/or equality of service within the CTO and CRBC. Routinely handles confidential patient information and sensitive financial information.
Authority
- Research Billing Compliance Analyst may be asked to assist with training new staff or correcting the work of others. Identifies and suggests process and operational improvements.
Communications
- Exchanges non-routine information using tact and persuasion as appropriate, requiring above average oral and written communication skills.
Special Knowledge, Skills & Abilities
- Requires a detail-oriented individual with the ability to handle a high volume of multiple tasks and follow through to completion.
- Must be able to learn quickly and work independently to address a variety of complex issues.
- Must be flexible to adjust to the development and refinement of new processes and procedures, as the scope of the CRBC and Clinical Trials Offices evolve within Johns Hopkins Medicine.
- CPT, E&M and ICD-10 hospital and/or professional coding required, including coding from clinical documentation or auditing the coding of others.
- Knowledge of Medicare's regulations regarding clinical research coverage, teaching physicians and documentation guidelines, and other federal and state laws and regulations concerning clinical documentation, coding, and reimbursement for hospitals and/or physicians required. Knowledge of related clinical and business practices, policies, and procedures for billing and collection of hospital and professional fee services, and audit processes preferred.
- Demonstrated communication, analytical and organizational skills are essential. Proficient in Microsoft Office applications including Excel and Word, Outlook or equivalent e-mail, and internet usage. Familiar with Access data bases. Experience with hospital and professional fee billing systems, electronic health records, and other clinical information systems preferred. Must be self-motivated and comfortable working independently, as a team leader and as a team member.
Physical Requirements
- Sitting in a normal seated position for extended periods of time.
- Reaching by extending hand(s) or arm(s) in any direction.
- Finger dexterity required to manipulate objects with fingers rather than with whole hand(s) or arm(s) e.g., use of keyboard.
- Communication skills, using the spoken word.
- Ability to see within normal parameters, ability to hear within normal range and ability to move about.
*This description is a general statement of required major duties and responsibilities performed on a regular and continuous basis. It does not exclude other duties as assigned.
Minimum Qualifications
- Bachelor's Degree in health care-related or business-related field, or five years of recent, direct experience with third party payer requirements for hospitals or physicians required. Medical Terminology, Anatomy & Physiology courses or demonstrated knowledge of disease processes required.
- Minimum of two years of auditing/billing compliance or clinical research-related experience required. Five years of experience preferred. Recent experience with Medicare regulations preferred. Some experience with clinical research billing preferred.
- Master's Degree in a health care related discipline may be substituted for up to one year of experience. Additional years of related experience performed as a consultant with a recognized organization may be substituted at the rate of one year consultancy for two years of experience.
- Identifies and notifies the Lead Compliance Analyst of any issue with the PRA that requires resolution prior to determining how to process the claims. Works with Clinical Research Support Services (CRSS) Analysts and Research Staff to clarify discrepancies.
- Performs other research billing compliance related activities as necessary.
Preferred Qualifications
- A minimum of one professional coding certification (CCS-P, CCS, CPC, RHIA or RHIT) is preferred. If no coding certification upon hire, must obtain one certification within 12 months of employment.
Classified Title: Research Billing Compliance Analyst I
Role/Level/Range: ATP/04/PD
Starting Salary Range: $61,070-$83,900-$106,710 Annually (Commensurate with experience)
Employee group: Full Time
Schedule: M-F 8 am - 4:30 pm
Exempt Status: Exempt
Location: Remote
Department name: SOM Admin Res Clinical Research Contract
Personnel area: School of Medicine
Total Rewards
The referenced salary range is based on Johns Hopkins University's good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level. Johns Hopkins offers a total rewards package that supports our employees' health, life, career and retirement. More information can be found here: https://hr.jhu.edu/benefits-worklife/
Please refer to the job description above to see which forms of equivalency are permitted for this position. If permitted, equivalencies will follow these guidelines:
JHU Equivalency Formula: 30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience. Additional related experience may substitute for required education on the same basis. For jobs where equivalency is permitted, up to two years of non-related college course work may be applied towards the total minimum education/experience required for the respective job.
**Applicants who do not meet the posted requirements but are completing their final academic semester/quarter will be considered eligible for employment and may be asked to provide additional information confirming their academic completion date.
The successful candidate(s) for this position will be subject to a pre-employment background check. Johns Hopkins is committed to hiring individuals with a justice-involved background, consistent with applicable policies and current practice. A prior criminal history does not automatically preclude candidates from employment at Johns Hopkins University. In accordance with applicable law, the university will review, on an individual basis, the date of a candidate's conviction, the nature of the conviction and how the conviction relates to an essential job-related qualification or function.
The Johns Hopkins University values diversity, equity and inclusion and advances these through our key strategic framework, the JHU Roadmap on Diversity and Inclusion.
Equal Opportunity Employer
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
EEO is the Law
Learn more:
https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf
Accommodation Information
If you are interested in applying for employment with The Johns Hopkins University and require special assistance or accommodation during any part of the pre-employment process, please contact the Talent Acquisition Office at jhurecruitment@jhu.edu. For TTY users, call via Maryland Relay or dial 711. For more information about workplace accommodations or accessibility at Johns Hopkins University, please visit accessibility.jhu.edu.
Johns Hopkins has mandated COVID-19 and influenza vaccines, as applicable. Exceptions to the COVID and flu vaccine requirements may be provided to individuals for religious beliefs or medical reasons. Requests for an exception must be submitted to the JHU vaccination registry. For additional information, applicants for SOM positions should visit https://www.hopkinsmedicine.org/coronavirus/covid-19-vaccine/ and all other JHU applicants should visit https://covidinfo.jhu.edu/health-safety/covid-vaccination-information/.
The following additional provisions may apply, depending on campus. Your recruiter will advise accordingly.
The pre-employment physical for positions in clinical areas, laboratories, working with research subjects, or involving community contact requires documentation of immune status against Rubella (German measles), Rubeola (Measles), Mumps, Varicella (chickenpox), Hepatitis B and documentation of having received the Tdap (Tetanus, diphtheria, pertussis) vaccination. This may include documentation of having two (2) MMR vaccines; two (2) Varicella vaccines; or antibody status to these diseases from laboratory testing. Blood tests for immunities to these diseases are ordinarily included in the pre-employment physical exam except for those employees who provide results of blood tests or immunization documentation from their own health care providers. Any vaccinations required for these diseases will be given at no cost in our Occupational Health office.
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