DaVita Medicare Coverage Analyst in Minneapolis, Minnesota

This position provides Medicare coverage analysis (MCA) for clinical research studies conducted within the DaVita Kidney Care and DaVita Medical Group healthcare operations. This position reports to the Senior Director of Late Phase Research.

ESSENTIAL DUTIES & RESPONSIBILITIES

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Conducts coverage analysis for all proposed clinical research studies to be conducted within DaVita to determine clinical study billing eligibility under the MCA rules

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Review study protocols, sponsor agreements, informed consent forms and related documents as needed Analyze Medicare benefit policies, coverage determinations, and medical practice guidelines related to study specific interventionsand routine care

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Provides clear documentation of analysis with determination decisions and supporting conclusions toinclude the compliant and accurate categorization ofallservices, items, costsand expensesapplicable to theclinical research trialfor each study

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Works with budgets and client services teams to communicate MCA status for accurate budget preparation of study tasks for billing purposes to include the correct and appropriate [Serves as a resource to DCR teammates engaged in the preparation, review, negotiation, and management of research project budgets. Teammate will answer questions, review budget line items (as necessary) and assist with validating that all administrative costsand patient care expenses applicable to theclinical research trial are adequately documented in a research project’s financial plan ]

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Works with the Clinical Study Billing team, Billing Department and the Finance Department and Finance for DMG) to ensure accurate claims processing to include accurate clinical trial number and modifiers on study related services

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Works with DaVita ROPS teams to review held billing claims for proper processing and documentation prior to submission to Medicare

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Works with Compliance and DaVita ROPS when conducting MCA audits for accuracy and completeness

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Collaborate with the PI and the PI’s facility-based research team to finalize the MCA and designate funding sources forall items, services, costsand expenses

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Trains research study personnel in billing compliance and research billing operations associated withclinical research

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AssistDCRwith thereview, development andimplementation of institutional policies and procedures toassist compliance with federal, state and local laws and regulations related toclinical trial billing

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Provides direct supervision and work direction for department teammates

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Other duties as assigned

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BS/BA required.

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Minimum three (3) years of Medicare Coverage Analysis or clinical trial billing experience

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Ability to manage multiple projects, meet deadlines, and adjust priorities appropriately in an evolving work environment with shifting time frames; self-starter with high degree of initiative, urgency, and follow through.

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Innovative, analytical thinker with demonstrated ability to perform analysis, prepare and implement processes

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Travel required, less than 10%.

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Maintain confidential information and/or issues using discretion and judgment.

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The DaVita Village is committed to being an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability or protected veteran status.

We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.