NI-Billing Specialist Clinical Research

J  o  b    D  e  s  c  r  i  p  t  i  o  n

JOB INFORMATION

Effective Date:

3/22/2026

Entity:

Illinois

Job Code:

NI-4485AC

Job Title:

NI-Billing Specialist Clinical Research

FLSA Exemption Status:

Non-Exempt

JOB SUMMARY

Under the direction of the UW Health Manager of Oncology Clinical Support Services, the Clinical Research Billing Specialist will be responsible for performing: comprehensive research protocol-specific Medicare coverage analysis; routine audits research billing compliance audits; and documenting the rules, regulations, best practices, and internal policies to support their decisions, recommendations, and findings.

The incumbent shall work closely with staff from the (including but not limited to): Office of Clinical Trials; UWMF & UWHC Patient Accounting; ICTR Clinical Research Unit; Carbone Cancer Center; and UW research teams (investigators and their research coordinators) across the UW health sciences schools and regions.

ESSENTIAL DUTIES

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Use independent judgement and apply a comprehensive understanding of research regulations and policies in administering processes to ensure that clinical trials:

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Comply with CMS, FDA, and other governmental regulatory requirements related to research billing

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Utilize the UW Health “Medicare Billing Compliance Checklist” and/or other Program-designated tools.

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Include sufficient descriptive information to allow for proper coding and billing, as determined by UWHC/UWMF Patient Accounting

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Facilitate the application of UW Health’s “Medicare Research Billing Rules” to all clinical trials based on the Medicare National Coverage Determination Policy.

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Perform detailed reviews of protocols, budgets, informed consent documents, sponsor contracts, Notices of Grant Awards, FDA letters, and other relevant research documents to determine qualifying status and conduct a comprehensive Medicare Coverage Analysis review; making sure to document rationale for final decisions or recommendations.

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Provide research staff with UW Health codes, costs, and fees to ensure appropriate construction of study budget proposals

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Analyze Medicare benefit policies, refer to national/local treatment and medical practice guidelines, conduct relevant literature reviews, and consult with the investigator and other internal/external experts to support compliant Medicare coverage determinations.

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Add study accounts to Health Link in a timely manner and assure all applicable/impacted parties are notified of new clinical studies entering the Program’s domain (e.g., UW Health-IT; UWHC/UWMF Patient Billing Department, study staff).

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Perform routine research billing compliance audits of research accounts to ensure billing compliance, using the informed consent document, clinical trial agreement, and study budgets. Such review may also include working and confirming with study staff that their research accounts have not been inappropriately billed for items that should have been directed to insurance or waived.

As needed, additional responsibilities reasonably within the scope of duties and physical requirements may be assigned.  ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS AND RESPECT FOR PEOPLE COMMITTMENTS.

X

Non-Clinical

JOB REQUIREMENTS

Post-secondary education or certification in medical coding, business or health-related field.

Required

or

Three (3) years of experience in medical billing may be considered in lieu of post-secondary education or certification in addition to the experience below.

Required

Bachelor's Degree in business or heath-related field.

Preferred

1 year of coding or medical billing experience.

Required

Experience in an academic health system.

Preferred

Experience with Epic applications.

Preferred

Certified Professional Coder (CPC) or equivalent.

Preferred

LICENSE, CERTIFICATIONS, AND REGISTRATIONS MUST BE MAINTAINED PER UW HEALTH POLICY. 

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Working knowledge of the Centers for Medicare and Medicaid (CMS) Clinical Trial Policy.

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Working knowledge of medical terminology, medical billing, and billing compliance.

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Strong analytical, communication (written and oral) and complex problem-solving skills; proficient with spreadsheet/databases (e.g., Excel) and the use of other Microsoft Office programs (i.e. Word, PowerPoint, etc.).

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Ability to communicate effectively with research staff, investigators, and billing/accounting staff.

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Strong attention to detail and ability to adhere to policies and procedures Clinical Trial Management System .

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Knowledge of Epic and Clinical Trial Management Systems such as OnCore or Epic’s native system .

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Demonstrate attention to detail and the ability to methodologically review accounts to assure proper billing.

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Ability to learn applicable policies and procedures of various UW entities as well as applicable state and federal regulations and guidelines.

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Strong attention to detail and ability to adhere to policies and procedures.

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Ability to react to frequent changes in duties and volume of work.

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Effective communication skills.

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Work requires a high degree of organization and accuracy, and clear communication with all research and clinical trial stakeholder.

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Ability to manage multiple tasks with ease and efficiency.

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Self-starter with a willingness to try new ideas.

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Ability to work both collaboratively and independently.

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Must be result oriented.

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Work requires the ability to prioritize and handle large volumes of work.

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Positive, can-do attitude coupled with a sense of urgency.

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Effective interpersonal skills, including the ability to promote teamwork.

•

Knowledge of local, state, and federal healthcare regulations.

•

Maintain confidentiality of sensitive information.

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

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Sedentary: Sedentary work involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. Although a sedentary job is defined as one which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met.

Up to 10 lbs.

Negligible Weight

No Weight

☐

Light: Light work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls. To be considered capable of performing a full or wide range of light work, you must have the ability to do substantially all of these activities. If someone can do light work, we determine that they can also do sedentary work, unless there are additional limiting factors such as loss of fine dexterity or inability to sit for long periods of time.

11-25 lbs.

1 - 10 lbs.

Negligible weight

☐

Medium: Medium work involves lifting no more than 50 pounds at a time with frequent lifting or carrying of objects weighing up to 25 pounds. If someone can do medium work, we determine that they can also do sedentary and light work.

26-50 lbs.

11-25 lbs.

1 - 10 lbs.

☐

Heavy: Heavy work involves lifting no more than 100 pounds at a time with frequent lifting or carrying of objects weighing up to 50 pounds. If someone can do heavy work, we determine that they can also do medium, light, and sedentary work.

51-100 lbs.

26-50 lbs.

11-25 lbs.

☐

Very Heavy: Very heavy work involves lifting objects weighing more than 100 pounds at a time with frequent lifting or carrying of objects weighing 50 pounds or more. If someone can do very heavy work, we determine that they can also do heavy, medium, light, and sedentary work.

Over 100 lbs.

Over 50 lbs.

Over 25 lbs.

Other - list any other physical requirements or bona fide occupational qualifications not indicated above:

Over 50 lbs.

UW Health does not require, nor does it expect that its employees lift more than 50 lbs unassisted. Objects in excess of 50 lbs should be lifted or moved with mechanical means or through a team lift. Employees in patient care areas are expected to utilize mechanical lifts and adhere to the "Use of Mechanical Lifts (Liko)" policy in the Patient Services Policy and Procedure Manual.

Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.

THE EMPLOYEE MUST BE ABLE TO COMPLETE ALL PHYSICAL REQUIREMENTS OF THE JOB WITH OR WITHOUT AN APPROVED ACCOMODATION. Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.