Clinical Trials Revenue Cycle Billing Compliance (Research Regulatory Oversight / Sr. Enterprise Financial Mgmt) (CHRC or CHC cert preferred) - REMOTE

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The Regulatory Oversight Specialist – Research (non-supervisory) is responsible for planning and leading projects related to the management of clinical research. Reviews will include but may not be limited to performing prospective review of study protocols, billing grid development and research charge segregation activities.  Study activities reviewed evaluate compliance with CMS regulations for billing of research studies (Medicare Coverage Analysis, claim presentation, and billing of charges to federal grants/sponsored projects.  Review of EPIC charge transactions and chart documentation will be required as part of work assignments. 

The Regulatory Oversight Specialist – Research position wis expected to work independently and have strong analytical and regulatory knowledge related to the management and billing of clinical trials and clinical registries.  The position will require intermediate to expert skills in assembling and analyzing data in Excel, reviewing professional and hospital charging and billing/collection transactions in EPIC, and providing accurate and concise PowerPoint summaries to various departments including Revenue Cycle, Office of Legal Counsel, Office of Compliance and Research Administration. 

• →Lead prospective and retrospective reviews of study protocols, billing grid development and research charge segregation functions. 
• →Analyze compliance with CMS regulations for billing of research studies and clinical registries by auditing Medicare Coverage Analysis, Coverage with Evidence Development (CED) guidelines, medical documentation in EPIC, and insurance and patient billing and collection transactions. 
• →Perform special projects related to compliance matters as requested by Office of Compliance and Corporate Integrity and/or Office of Legal Counsel. 
• →Analyze data files in Excel to evaluate compliance with criteria under review and document findings and key recommendations in a clear and concise manner.
• →Lead complex financial, operational, reimbursement, and business analyses.
• →Interpret and communicate analytical findings and recommendations to leadership.
• →Present key findings and recommendations to executive level management. 
• →Support legal, compliance and research administration leadership, and finance committee reporting requirements.
• →Lead initiatives to improve CMS regulatory oversight monitoring and control processes.
• →Evaluate clinical trials management systems, workflows, and reporting tools and recommend enhancements.
• →Promote standardization and best practices across enterprise financial processes.
• →Identify opportunities to leverage technology, automation, and analytics to improve effectiveness.
• →Assist in establishing work priorities, project objectives, and departmental goals related to the Regulatory Oversight function. 
• →Foster a culture of accountability, collaboration, innovation, and continuous improvement.
• →Maintain updated knowledge of federal and state regulatory changes pertaining to areas in scope of functional oversight.
• →Contribute to major finance department projects and organizational priorities.
• →Perform other duties as assigned.

Bachelor’s Degree and 10 years of relevant work experience preferably in Research Administration, Clinical Trials Management, Revenue Cycle, Consulting or Auditing in a Large Academic Medical Center.  CHRC (Certification in Healthcare Research Compliance) and/or CHC (Certified in Healthcare Compliance) preferred.  Familiarity with OnCore Clinical Trials Management System strongly preferred. 

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This role offers the opportunity to make a meaningful impact within Vanderbilt Health, supported by a comprehensive benefits package which may include health, disability, retirement and/or wellness offerings to enhance your well-being and professional growth.

Vanderbilt Health is committed to fostering an environment where everyone has the chance to thrive and is committed to the principles of equal opportunity.  EOE/Vets/Disabled.