Charge Segregation Manager

Job Description Summary

Under the direction of the Office of Clinical Research Associate Director of PRA, the Senior Charge Segregation Analyst will serve as the technical expert for complex research billing workflows, providing ongoing updates and training to existing staff and study teams. The Senior Charge Segregation Analyst will be responsible for performing comprehensive research protocol-specific reviews in Epic using the current coverage analysis to review, approve, and release Epic Research charges timely and compliantly in alignment with defined metrics in collaboration with Revenue Cycle. Form collaborative partnerships with MUSC Health Revenue Cycle, Epic teams, CTMS Team and Compliance Offices to support the mission of creating a compliant and effective centralized research billing review program. Engage in continuous quality improvement activities and seek streamlined and automated bill review processes.

Entity

Medical University Hospital Authority (MUHA)

Worker Type

Employee

Worker Sub-Type​

Regular

Cost Center

CC005226 SYS - HB Support Services

Pay Rate Type

Salary

Pay Grade

Health-31

Scheduled Weekly Hours

40

Work Shift

Job Description

Job Requirements:

• Advanced knowledge of various research program billing requirements, as well as Medicare, Medicaid, and federal research billing rules. Use independent judgment and apply a comprehensive understanding of research regulations and policies to ensure clinical trials comply with CMS, FDA, and other governmental regulatory requirements related to research billing.
• Demonstrate attention to detail and the ability to methodologically review accounts to ensure proper billing in a timely manner.

• Apply Medicare Research Billing Rules to all clinical trials based on the Medicare Clinical Trial Billing Policy, National Coverage Determination 310.1". 

• Escalate and document research billing issues discovered during the Epic billing review.
• Perform training and remediation for study teams of charge errors discovered during Epic review that occur due to study team errors.
• Communicate with Revenue Cycle teams, and others to resolve account problems
• Participate in meetings as needed to address any potential research billing concerns.
• Collaborate with the clinical research department administrators and study coordinators in the development and implementation of educational activities related to charge capture improvement projects.
• Work with Rev Cycle to review and validate any research adjustments to accounts in the insurance portfolio based on insurance reimbursement, coverage, contracts, and services provided.
• Work with Rev Cycle to review any charge-related corrections, additions, and removals in Epic for both hospital and physician billing to ensure organizational compliance with all state and federal regulations.
• Ability to learn applicable policies and procedures of various entities as well as applicable state and federal regulations and guidelines.

Additional Job Description

Education: Bachelors Degree or equivalent Work Experience: 4-6 years

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

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