Clinical Research Coverage Analyst

Coverage Analyst

The Coverage Analyst is dedicated to ensuring billing compliance for clinical research and supports utilization of the Clinical Trial Management System (CTMS), Oncore. The Coverage Analyst plays a crucial role in evaluating clinical research protocols, informed consent forms, clinical trial budgets, and other pertinent study documents to generate a protocol calendar in the CTMS system and develop coverage analysis/billing grid. The Coverage Analyst specifies which procedures and services may qualify as 'Routine Cost' and be billable to patient insurance, and which should be charged to the study. The Coverage Analyst is responsible for determining whether proposed clinical research studies meet the criteria for a Qualifying Clinical Trial as defined by the Medicare Clinical Trial Policy (NCD 310.1). As a member of the Research Systems & Coverage Analysis (RSCA) Unit, within the Office of Clinical Research, the Coverage Analysts works as part of a team to support and optimize clinical trial initiation and financial workflows, partnering closely with research teams and key stakeholders in the process.

Responsibilities

• Reviews clinical trial protocols, budgets, contracts, and informed consent documents to inform billing designations.
• Creates detailed coverage analyses that outline the billing of clinical items and services required by research studies.
• Develops study calendars within the Clinical Trial Management System, Oncore.
• Ensures consistency in the application of Medicare and other applicable rules across studies and alignment of study documents with billing regulations.
• Works collaboratively with key offices, including the Human Research Protection Program and research units, to harmonize regulatory and budgetary processes in clinical trials.
• Communicates the results of coverage analyses to principal investigators and/or study teams, providing detailed explanations and addressing any questions or concerns.
• Ensures that coverage analyses outputs are reviewable and auditable for quality and compliance.
• Recruits, onboards, and trains new clinical research staff to ensure adherence to billing compliance procedures.
• Coordinates department or clinic compliance with a moderate level of guidance.
• Prepares, completes and submits all compliance documentation on a routine basis. Coordinates compliance committee meetings.
• Performs other related work as needed.

Minimum Qualifications

Education: Minimum requirements include a college or university degree in related field.

Work Experience: Minimum requirements include knowledge and skills developed through 2-5 years of work experience in a related job discipline.

Preferred Qualifications

• Bachelor's degree.
• Clinical research experience such as clinical research conduct, regulatory compliance, or related research activities.
• Coverage analysis experience.

Preferred Competencies

• Interpret research protocols, budgets, and consent forms to extrapolate billing/coverage information.
• Problem-solve, leveraging information and expertise available.
• Strong organizational skills.
• Manage projects at various stages of completion.
• Manage high volume of workload and meet deadlines.
• Demonstrated attention to detail.

Working Conditions

• Office environment.

Application Documents

• Resume (required)
• Cover Letter (preferred)

The University of Chicago offers a wide range of benefits programs and resources for eligible employees, including health, retirement, and paid time off. Information about the benefit offerings can be found in the Benefits Guidebook.

The University of Chicago is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender, gender identity, or expression, national or ethnic origin, shared ancestry, age, status as an individual with a disability, military or veteran status, genetic information, or other protected classes under the law.