Research Billing Specialist

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

JOB INFORMATION

Effective Date:

3/1/2022

Entity:

Wisconsin

Job Code:

450020

Job Title:

Research Billing Specialist

FLSA Exemption Status:

Non-Exempt

Management Level:

Individual Contributor

JOB SUMMARY

Under the general supervision of a Revenue Cycle Supervisor, the Research Billing Specialist is responsible for reviewing charges for all patients related to clinical trials, for all service lines, based on Medicare Coverage rules and Clinical Trial contracts to ensure proper compliance and reimbursement. The Specialist is engaged in proactive and independent line-item review of charge related items/encounters within UW Health in collaboration with clinical research departments, while ensuring that performance metrics are at or above standardized levels.  

This position requires advanced knowledge of various research program billing requirements, as well as Medicare, Medicaid, and federal research billing rules. The incumbent actively participates in internal audits, maintains documentation of current workflows, assists with special projects, and works closely with the Research Compliance Department, the Office of Clinical Trials, IT, and Department Managers.

The Specialist participates in quality improvement initiatives to improve accounts receivable and improve accuracy and efficiency. In addition, the Specialist is the primary contact responsible for answering questions regarding team functions, accurate and timely processing of study-related charges and responding to any concerns/appeals of various research coordinators and payers.  

The Research Billing Specialist will serve as the technical expert for complex research billing workflows, providing ongoing updates, and training to existing staff. The Specialist is responsible for working account workqueues, charge review edits, claim edits, denials, etc. while ensuring the accuracy and completeness of all research-related charges within EPIC for accurate and timely billing to study accounts, insurance/Medicare, and/or the patient.

ESSENTIAL DUTIES

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Core Responsibilities:

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Maintaining a complete portfolio of accounts receivable for area of expertise. This includes following accounts through the revenue cycle, from charge review, account workqueues, claim edits, and claim submission. This includes:

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o Resolving claim edits via claim edit work queues and/or our external billing software

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o Reviewing charges daily that are in the Epic charge router review work queues, charge review work queues, and Epic generated reports to segregate them as standard-of-care services, research-related services, or indeterminate services

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o Following federal and state regulations to ensure compliance standards are met

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o Credit and charge accounts to create clean insurance accounts and research only charge accounts

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o Ensure that professional fees are adjusted the same way that technical fees are adjusted

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o Will drive and coordinate processes to secure maximum revenue from study fees through timely and accurate billing and collection

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Verify patient coverage information and update registration as required

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Refer to study documents, study protocol, informed consent form, Clinical Trial Agreement (CTA) and budget to review new research patient accounts for patient care charges associated with each clinical research project on a regular basis utilizing the OnCore system

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Identifies appropriate use of billing modifiers and other CMS requirements for billing research-related charges to federal and non-federal payors

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Performs remediation of charge errors discovered during EPIC review

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Communicate with Revenue Cycle teams, payors, and others to resolve account problems; participate in meetings as needed to address any potential payor concerns

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Collaborates with the clinical research department administrators and study coordinators in the development and implementation of educational activities related to charge capture improvement projects

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Review and validate adjustments to accounts in the insurance portfolio based on insurance reimbursement, coverage, contracts, and services provided

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Processes charge related corrections, additions, and removals in EPIC for both the hospital and physician billing to ensure organizational compliance with all state and federal regulations

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Involved in developing strategy for maximizing financial opportunities in the conduct of research through accurate and timely charge review

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Complete work on special projects, queries and reports as assigned

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Attends training classes, as determined by management

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Provide general assistance with team:

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o Complete quality improvement and productivity activities

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o Answer questions regarding team functions and assist with team direction

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o Assist in training staff as needed

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Customer Service Standards:

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Support co-workers and engage in positive interactions

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Address research billing questions from research team members and other research clinical/operations staff

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Communicate professionally and timely with internal and external customers

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Provide helpful assistance in anticipating and responding to the needs of our customers

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Ability to stay calm under pressure and deal effectively with difficult people

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

Associate's Degree

in Health Care, Business, or a related field.
Two (2) years of research billing, financial analysis, or coding experience may be considered in lieu of degree in addition to the experience below.

Required

or

Two (2) years of research billing, financial analysis, or coding experience may be considered in lieu of degree in addition to the experience below.

Required

Bachelor's Degree

in Business, Finance, Health Information Management, or related field.

Preferred

2 years

of experience in a healthcare revenue cycle or clinic operations role and Epic billing experience.

Required

1 year

of research billing or research operations.

Required

Experience working in OnCore.

Preferred

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

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Understanding of Medicare billing rules and functional knowledge of essential National Coverage Decisions and the new CMS Clinical Research Policy

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Working knowledge of Epic and Oncore systems

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Working knowledge of hospital charge capture flow

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Advanced analytic ability

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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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Knowledge of key research financial regulations regarding research (e.g., FDA / OHRP / ORI / DHHS / NIH) preferred

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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 independently and 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

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Strong problem-solving skills

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Excellent PC operating skills (keyboard, mouse) and use of MS Office

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Broad knowledge of health care business office practices and principles

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Basic math skills and knowledge of general accounting principles

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Knowledge of medical and insurance terminology, CPT, ICD coding structures, and billing forms (UB, 1500)

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Maintain confidentiality of sensitive information

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Knowledge of Business Office policies and procedures

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Knowledge of local, state, and federal healthcare regulations

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Knowledge of Microsoft Office

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

☒

Sedentary: Ability to lift up to 10 pounds maximum and occasionally lifting and/or carrying such articles as dockets, 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 only occasionally and other sedentary criteria are met.

Up to 10#

Negligible

Negligible

☐

Light: Ability to lift up to 20 pounds maximum with frequent lifting and/or carrying of objects weighing up to 10 pounds. Even though the weight lifted may only be negligible amount, a job is in this category when it requires walking or standing to a significant degree.

up to 20#

Up to 10# or requires significant walking or standing or requires pushing/pulling of arm/leg controls.

Negligible or constant push/pull of items of negligible weight

☐

Medium: Ability to lift up to 50 pounds maximum with frequent lifting and/or carrying objects weighing up to 25 pounds.

20-50#

10-25#

Negligible-10#

☐

Heavy: Ability to lift up to 100 pounds maximum with frequent lifting and/or carrying objects weighing up to 50 pounds.

50-100#

25-50#

10-20#

☐

Very Heavy: Ability to lift over 100 pounds with frequent lifting and/or carrying objects weighing over 50 pounds.

Over 100#

Over 50#

Over 20#

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.