Clinical Trials Medicare Coverage Analyst

Clinical Trials Medicare Coverage Analyst

Vitalief is a consulting and professional services firm that partners with clinical research sites, sponsors, and CROs to improve trial activation, operational performance, and workforce readiness. By combining clinical research expertise with operational and business excellence, we help organizations streamline processes, reduce costs, accelerate timelines, and enhance patient outcomes.

We are seeking a full-time, fully benefited Vitalief employee to serve as a Clinical Trials Medicare Coverage Analyst in a fully remote capacity, supporting Vitalief's client, a leading academic clinical research center in the Chicago area. The ideal candidate brings strong expertise in Medicare billing guidelines, clinical trial operations, experience working on Oncology protocols, and OnCore calendar builds, and will ensure compliance while supporting clinical trial billing operations and advising key stakeholders.

Key Responsibilities

• Conduct Medicare Coverage Analyses (MCA) for a mixture of oncology and non-oncology clinical trial protocols identifying which procedures and services are billable to Medicare versus those considered research related.
• Review clinical trial protocols, schedules of events, and informed consent forms to ensure billing compliance with CMS regulations.
• Develop, maintain, and validate OnCore calendar builds for clinical trial visits, procedures, and study milestones.
• Collaborate with cross-functional teams including Clinical Operations, Finance, Regulatory, and Study Teams to provide guidance and clarification on coverage decisions.
• Prepare and maintain coverage analysis documentation, summary tables, and billing justification reports for both internal and external stakeholders.
• Serve as a subject matter expert for Medicare coverage rules, assisting study teams in identifying potential billing risks and providing actionable recommendations.
• Support internal and external audits, ensuring all coverage decisions are well-documented and compliant with federal and sponsor requirements.
• Keep current with CMS updates and industry best practices, applying knowledge to optimize coverage analyses and study operations.

Qualifications

• Bachelor's degree in Healthcare Administration, Medical Coding, Auditing, Finance, Accounting, Nursing, or a related field.
• Minimum 2 years of Medicare Coverage Analysis experience supporting clinical research studies for an Academic Medical Center (AMC) or health (hospital) system.
• Must have experience working on oncology clinical trial protocols.
• Hands-on experience developing, maintaining, and validating OnCore calendar builds for clinical trial visits, procedures, and study milestones is preferred but not required as training will be provided.
• Strong understanding of CMS guidelines, Medicare billing compliance, and clinical trial operations.
• Demonstrated ability to work independently and manage multiple protocols and deadlines simultaneously.
• Exceptional attention to detail, analytical skills, and problem-solving abilities.
• Strong written and verbal communication skills, with the ability to explain complex billing concepts to non-technical stakeholders.
• Comfortable working in a fully remote environment, collaborating effectively with distributed teams across multiple locations.
• Proficiency in document and data management tools, including Microsoft Word, Excel, PowerPoint, Adobe, Teams, and SharePoint.

Physical Demands: Standing, sitting, walking, visual perception, talking and hearing. Lifting up to 20lbs.