Quality Assessment (QA) and Medicare Coverage Analysis Operations Associate (FT) - Full-time / Part-time

Completes various tasks related to Quality Assessment (QA) and Medicare Coverage Analysis (MCA) management of clinical trials.  These tasks include, but are not limited to: QA of Medicare Coverage Analyses (MCAs) for all clinical trials, maintenance of the Dartmouth study MCA/QA related document management, assisting research teams with QA of all studies, routing of MCA documentation for approval, ensuring all required internal and external approvals are granted prior to release of the study related expenses, and other related study management activities as instructed by the CTBO Manager.   

Responsibilities:

1. Medicare Coverage Analysis and Related Support:

1. Performs Medicare Coverage Analyses as appropriate for all studies, including entering the appropriate HCPCS and CDM codes for items and services to complete the Billing Grid and determining if conventional care items/services qualify for Medicare coverage.

1. Clinical Trials Registry and Other Document Management:

1. Coordinates with Research Teams to validate the study and patient data in the Registry and to ensure data is consistent with the Dartmouth Billing System and the IRB Database.  Manages receipt of and upload all appropriate study related documents. 

1. Assumes responsibility for coordinating, scheduling, and implementing complex professional MCA/QA compliance review and process.
2. Reviews documentation to establish compliance with MCA billing plan, informed consent, contract and other related documents.  
3. Analyzes and reports on data from compliance QA activities to identify trends, issues and risk areas.
4. Provides clear and concise recommendations to CTO leadership and administrators regarding MCA/QA requirements.
5. Prepares reports for CTO leadership and administrators.
6. Provides annual group education and training on MCA guidelines, and general QA compliance awareness.
7. Responds to MCA/QA from Revenue Management Department (RMD) and Compliance and Audit Services (CAS).  Maintain tracking system for responses.
8. Serves as liaison to Revenue Management Coding Operations.
9. Serves as knowledge resource for CMS issue resolution; may provide guidance, in coordination with Business Operations Associate (BOA) to Revenue Management bill reviewer.
10. Assists in developing MCA/QA policies and procedures.
11. Maintains expert knowledge of Center for Medicare Services regulations and offer guidance.
12. Meets and maintains established continuing education, productivity and performance standards.  Maintains current information on reimbursement and coding trends through membership in professional organizations, attendance at conferences and workshops, relationships with payers, resource materials and publications thereby ensuring that current information is secured, maintained and distributed to providers.
13. Actively participates in study resource meetings and acts as the primary CTO liaison to PI and research staff.
14. Participates in the development of and make periodic updates to Clinical Trials Business Operations policies and procedures.
15. Maintains a working knowledge of medical coding principles, governmental regulations, protocols, and third party requirements regarding clinical research billing and documentation.
16. Attends regular internal training and education.
17. Trains or assists in training new Clinical Trial Business Office Associates to ensure uniformity and quality of work.
18. Maintains confidentiality in all aspects of communication.
19. Performs other duties as required or assigned.