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

Discover Vanderbilt Health: With eight hospitals and over 180 clinics, we are the region’s largest comprehensive academic health system. Vanderbilt Health has a long tradition of providing world-class care to the people of the Mid-South, living out our mission of moving medicine forward through preeminent programs in patient care, education and research. Here you’ll find a spirit of collaboration and a supportive community where your expertise is valued, your knowledge expanded and your uniqueness celebrated. We are committed to fostering an environment where talented, compassionate people are united in bringing the most advanced care to our neighbors throughout the region.

Organization:

ChargeMaster Admin

Job Summary:

Perform prospective reviews of research related/clinical trial processes that directly impact the integrity of billing to federal/non-federal sponsors and claims billed to governmental and non-governmental payors. Assists with audits of information related to study protocols/grid development, Medicare Coverage Analysis audits, and audits of charge segregation functions impacting billed charges to federal grants, sponsored contracts and insurance payors. Special projects may arise from requests made by senior revenue cycle leadership, Office of Legal Counsel, Office of Compliance and Corporate Integrity and Research Executive Administration.

Should be able to initiate and plan projects with a high degree of autonomy and provide summaries of issues and corrective actions to various levels of executive leadership. Analysis of impacts to insurance and patient billing will be audited as part of project assignments. The non-supervisory position reports to the AVP of Finance, VP of Revenue and Reimbursement, or other designated finance executive within the Office of Finance/Revenue Cycle.

.

• CHRC (Certification in Healthcare Research Compliance) and/or CHC (Certified in Healthcare Compliance) preferred.

• Familiarity with OnCore Clinical Trials Management System strongly preferred.

Job Description:

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.

Essential Duties and Responsibilities:

• 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.

Qualifications:

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.

Our professional administrative functions include critical supporting roles in information technology and informatics, finance, administration, legal and community affairs, human resources, communications and marketing, development, facilities, and many more.

At our growing health system, we support each other and encourage excellence among all who are part of our workforce. High-achieving employees stay at Vanderbilt Health for professional growth, appreciation of benefits, and a sense of community and purpose.

Core Accountabilities:

* Organizational Impact: Plans and sets own objectives to deliver against responsibilities that have a direct impact on the near term results of a system or institution. * Problem Solving/ Complexity of work: Solves highly complex problems and recommends solutions that may have broad impact to the function.* Breadth of Knowledge: Viewed as the technical expert at VUMC within a professional area and a broad knowledge of other professional areas. * Team Interaction: Leads complex project teams; coaches and guides team members and develops strategy for project execution.

Core Capabilities :

Supporting Colleagues: - Develops Self and Others: Acts upon constructive feedback from all levels of the organization and initiates strategies to develop talent in others. - Builds and Maintains Relationships: Leverages relationships and insight to forecast potential future needs and influence delivery of work to exceed expectations. - Communicates Effectively: Anticipates difference audience concerns, styles and finds mutually beneficial solutions across conflicting and sensitive issues. Delivering Excellent Services : - Serves Others with Compassion: Demonstrates in-depth knowledge of broad-based issues and considers the interests of others to improve satisfaction of services. - Solves Complex Problems: Critically evaluates complex information and identifies trends/risks to make recommendations to improve processes across areas. - Offers Meaningful Advice and Support: Provides ongoing feedback and development discussions to motivate and support team members to maximize performance. Ensuring High Quality : - Performs Excellent Work: Anticipates problems or obstacles which may interfere with quality standards and develops plants to ensure area's quality standards are met.- Ensures Continuous Improvement: Routinely draws upon valuable learning from others, past experiences, and new information to determine key opportunities. - Fulfills Safety and Regulatory Requirements: Develops appropriate corrective actions for unsafe environments in order to ensure operational and safety compliance. Managing Resources Effectively: - Demonstrates Accountability: Identifies potential obstacles to goal achievement and develops solutions to address those obstacles. - Stewards Organizational Resources: Creates the appropriate systems and processes to effectively manage resources. - Makes Data Driven Decisions: Applies in-depth knowledge of data to recommend and implement new approaches to improve decision making capabilities. Fostering Innovation: - Generates New Ideas: Identifies opportunities and leads development of new initiatives that create value across areas. - Applies Technology: Creates the energy and drive for self/others to identify and leverage technology in new, innovative ways to drive greater efficiencies. - Adapts to Change: Anticipates the change process and clearly communicates impact on others/own team(s), assisting them in embracing the change.

Position Qualifications:

Responsibilities:

Certifications:

Work Experience:

Relevant Work Experience

Experience Level:

10 years

Education:

Bachelor's

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.

About Us

PEOPLE ARE AT THE HEART OF ALL WE DO.

Great health care takes great people.

We’re looking for like-minded individuals driven to make a difference. We invite you to explore careers at Vanderbilt Health, where we value collaboration, embrace continuous learning and foster an environment where everyone can thrive.

We’re the largest private employer in Middle Tennessee, with a growing team and an expanding footprint across towns and communities throughout the region.

We employ more than 43,000 people who work in inpatient and outpatient clinical care, research and graduate medical education. Our employees also serve in critical supporting roles in administration, information technology and informatics, finance, legal and community affairs, communications and marketing, fundraising, groundskeeping and facilities, and many other departments.

Our growing academic health system has more than 2,100 licensed hospital beds at eight hospitals:

• Vanderbilt University Hospital
• Monroe Carell Jr. Children’s Hospital at Vanderbilt
• Vanderbilt Psychiatric Hospital
• Vanderbilt Stallworth Rehabilitation Hospital
• Vanderbilt Bedford Hospital
• Vanderbilt Clarksville Hospital
• Vanderbilt Tullahoma-Harton Hospital
• Vanderbilt Wilson County Hospital

Vanderbilt Health is the Mid-South's largest provider of specialty care, with hundreds of outpatient clinic and surgical locations throughout the region, and Tennessee’s only National Cancer Institute-designated Comprehensive Cancer Center for adults and children. We are one of the nation's busiest critical care centers, home to Middle Tennessee’s only Level 1 Trauma Center and Burn Center for adults and children, and Middle Tennessee’s only Level IV Neonatal Intensive Care Unit. We are the nation’s largest transplant center, and last year we performed the most heart transplants than any center worldwide.

Vanderbilt Health is an epicenter for biomedical research, winning over $1 billion in annual research awards from government, industry, foundations and donors. We are also a national leader in medical training and education, with the largest clinical training center in the Mid-South and the only training center in Tennessee for many adult and pediatric specialties.

We’re honored to be consistently considered among the nation’s best hospitals for quality, safety and patient satisfaction. Three of our hospitals — Vanderbilt University Hospital, Vanderbilt Psychiatric Hospital and Vanderbilt Wilson County Hospital — have been awarded a Five-Star Quality Rating from Medicare.

We support each other and encourage excellence among every member of our workforce. High-achieving employees stay at Vanderbilt Health for professional growth opportunities, competitive compensation and benefits, and a sense of community and purpose.

Join us in advancing health care.

Our vision: The world leader in advancing personalized health

Our mission: Personalizing the patient experience through our caring spirit and distinctive capabilities