New

Lead Payor Coverage Analyst - Clinical Trials Office

The Pennsylvania State University
remote work
United States, Pennsylvania, Hershey
Apr 04, 2025
APPLICATION INSTRUCTIONS: CURRENT PENN STATE EMPLOYEE (faculty, staff, technical service, or student), please login to Workday to complete the internal application process. Please do not apply here, apply internally through Workday. CURRENT PENN STATE STUDENT (not employed previously at the university) and seeking employment with Penn State, please login to Workday to complete the student application process. Please do not apply here, apply internally through Workday. If you are NOT a current employee or student, please click "Apply" and complete the application process for external applicants. JOB DESCRIPTION AND POSITION REQUIREMENTS: The Penn State College of Medicine, Nursing Administration Clinical Trials Office, in Hershey, PA is seeking a Lead Payer Coverage Analyst. The Lead Payer Coverage Analyst is an integral member of the Penn State College of Medicine Clinical Trials Office (CTO). The primary purpose of this position is to conduct payer coverage analyses by reviewing and evaluating oncology and non-oncology clinical research protocols and related regulatory documents to prepare a billing plan for all billable items and services required in a clinical research project. This lead position is responsible for interviewing, training, and mentoring CTO lower-level payer coverage analysis staff, including directing work assignments and teaching best practices for performing a coverage analysis of oncology and non-oncology clinical research studies. The Payer Coverage Analyst will conduct the coverage analysis for all applicable research studies in accordance with Medicare's Clinical Trial Policy (NCD 310.1) and make to ensure that billing determinations to ensure compliance with national and local guidelines and for both routine and research services is handled appropriately and in compliance with all other applicable statutory requirements. As necessary throughout the life cycle of the study, the Payer Coverage Analyst will engage with study team, post award team, patient financial services, Research Quality Assurance, the IRB and other departments as necessary to ensure and facilitate billing compliance. Payer Coverage Analysis: Reviews trial related documents (i.e., protocol, consent, grant/trial agreement, budget, Investigator's Brochure, etc.) for new and amended research protocols submitted to the Clinical Trials Office. Identifies billable items and services based on trial related documents provided Interprets and applies knowledge of billing guidelines as identified in national and local coverage determinations, compendia, and literature support as needed to make billing determinations of items and services within a research protocol. Meet and discuss with research team (investigators, research staff, financial analysts) and CTO Clinical Research Budget Analysts any potential concerns identified with the payer coverage analysis Budget Development Support: Drafts the Coverage Analysis Review and Study Billing Grid(s) to direct payer coverage analysis, identifying billable items and services, and assigning billing determinations Attends budget meetings to facilitate discussion with the study team related to billing determinations of items and services within a research protocol. Meets with CTO Clinical Research Budget Analysts to review billing determinations in establishing a research protocol budget. Clinical Trial Management System (CTMS) Study Design and Management: Assists with building of clinical trial studies into CTMS by converting the study protocol and negotiated budget into a user-friendly interface to ensure billing compliance and proper management of study funds. Continue user support throughout the life cycle of each trial, including making updates to studies in STAR based on protocol and/or coverage analysis. Collaborates with clinical research budget analysts, patient financial services, study teams, and post-award financial analysts to resolve research billing compliance issues. Departmental Training, Education and Supervision: Interviews, trains, and mentors CTO staff including directing work assignments and teaching best practices for performing payer coverage analysis of oncology and non-oncology clinical research. Monitors work performed by others in the payer coverage analysis process. Coordinate proposal submission and contract negotiation with Office of Research Affairs. Provides subject matter expertise to College of Medicine colleagues involved in all pre-award and post-award processes. Regulatory and Institutional Compliance: Completes the HRP-903 Radiation Review Form and the Ancillary Review for studies via CATS IRB, as applicable, collaborating with the Radiation Review Committee as necessary. Completes the CTO Ancillary Review for studies via CATS IRB, as necessary Institutional Training and Education: Develop faculty and research staff education programs on specialized research administration topics. Disseminate new knowledge and best practices through various platforms including but not limited to monthly Research Operations and Administrative Rounds, CTO workshops, and other ad hoc groups. Engage in one-on-one meetings with both faculty and research staff from other departments outside the CTO, as needed, to provide in-depth generalized clinical research training, as well as project-specific guidance. Hybrid and Remote work arrangements are available. This position will be filled at a Principal Professional or Senior Supervisor depending on the candidate's education and experience. This position requires a Bachelor's Degree and 6 + years of relevant experience or an equivalent combination of education and experience. Additional education and/or experience required for higher level positions. Previous budget development and negotiations of oncology and non-oncology clinical research required. The following clearances must be successfully completed for this position: Pennsylvania State Police Criminal Background Check Pennsylvania Child Abuse History Federal Bureau of Investigation (FBI) Criminal Background Check The Pennsylvania State University is committed to and accountable for advancing diversity, equity, and inclusion inall ofits forms.We embrace individual uniqueness, foster a culture of inclusive excellence that supports both broad and specific diversity initiatives, leverage the educational and institutional benefits of diversity, and engage all individuals to help them thrive. We value inclusive excellence as a core strength and an essential element of our public service mission. The salary range for this position, including all possible grades is: $68,200.00 - $115,100.00 Salary Structure - additional information on Penn State's job and salary structure. CAMPUS SECURITY CRIME STATISTICS: Pursuant to the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act and the Pennsylvania Act of 1988, Penn State publishes a combined Annual Security and Annual Fire Safety Report (ASR). The ASR includes crime statistics and institutional policies concerning campus security, such as those concerning alcohol and drug use, crime prevention, the reporting of crimes, sexual assault, and other matters. The ASR is available for review here. Employment with the University will require successful completion of background check(s) in accordance with University policies. EEO IS THE LAW Penn State is an equal opportunity, affirmative action employer, and is committed to providing employment opportunities to all qualified applicants without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. If you are unable to use our online application process due to an impairment or disability, please contact 814-865-1473. Federal Contractors Labor Law Poster PA State Labor Law Poster Affirmative Action Penn State Policies Copyright Information Hotlines Hershey, PA