COVID-19 Vaccination Information

Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

Search Our Jobs

   Current UPMC employees must apply in HR Direct

Research Billing Specialist

  • Job ID: 154032531
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours: Between 7:00 a.m. and 4:30 p.m.
  • Shift: Day Job
  • Facility: Pinnacle Health Cardiovascular Institute
  • Department: Research CV Institute
  • Location: 1000 North Front Street, Wormleysburg PA 17043
  • Union Position: No
  • Salary Range: $23.50 to $35.24 / hour

Description

Under direct supervision of the Clinical Manager Research, including clinical trial budgets, research grants, and other gifts-in-kind supporting clinical research throughout UPMC Central Pa. Complies with research and regulatory policies and procedures related to Medicare Coverage Analysis, research billing and financial administration of research grants. Primary role is to ensure accurate billing for patients enrolled in clinical trials in accordance with federal regulations to reduce both health system and individual provider legal and financial risk. Works collaboratively with all process owners to educate and ensure documentation which supports coding, charging and billing for all services provided to an individual patient enrolled in research, clinical trials or research grant. Understands the importance/impact of billing integrity in terms of patient management, cost efficiency, quality of service and the goals of scientific research; has regular contact with physicians and health care personnel

Responsibilities:

  • Provides subject-matter expertise for research billing practices and research billing compliance issues.Initial contact for researchers receiving financial support (sponsored clinical trials, research grants, gifts in kind).
  • Receives and reviews proposed budget along with the protocol, informed consent document, and other study related documents.
  • Completes budget analysis, in coordination with researcher/research team, tracking which activities are research related compared to standard care.
  • As applicable, conducts Medicare Coverage Analysis to determine appropriate payer source for clinical trial services applying coverage rules to develop budget justification in the trial budget.
  • Negotiates and finalizes budget with sponsor or guarantors.
  • Assists researcher or research team members in setting up and maintaining appropriate billing and tracking processes for research related charges in the appropriate software programs.
  • Runs monthly report through the preferred IT system for research charges posted to research
  • Provides preliminary review of technical and professional charges in research guarantor account and identify if they are posted to the correct payor, then review findings with Principal Investigator or research team.
  • Documents all billing corrections to be made.  Corrects charges billed in error to research that should be paid by insurance, by performing a research correction/transfer in the IT system.  Corrects charges billed in error to insurance that should be research, by performing a research correction/transfer in IT system.
  • Makes Professional Billing corrections in IT system. Determines the Medicare rate for the services charged and calculate the adjustment between the charged rate and the Medicare rate for legitimate research accounts.
  • Prepares and distributes a spreadsheet for Billing to post payments/adjustments to the individual research HARs. Prepares and distributes a spreadsheet for Finance to post the research expenses/adjustments
  • Reviews actual charge and makes corrections in IT system after statements drop, as necessary.
  • Develops and oversees Standard Operating Procedures (SOPs) for charging, billing and collection of payments for research studies across Central Pa.
  • Assists with negotiating a Central Pa standardized research service pricing, updating it annually and clarifying budgets in relation to the study protocol, study calendar and other study related documenting in accordance with clinical trials budgeting policy. Provides primary support and oversight of the health system's clinical trial management system (CTMS).
  • Responsible for the development of SOPs, user training, review of CTMS specifications and provides day-to-day support for all research staff using the CTMS to maintain valid/accurate data and CTMS integrity. Creates reports for clinical research staff to review to reduce customer service issues by correctly identifying charges that are trial related.
  • Assists in the analysis of processes and recommends changes/modifications to meet compliance and customer service goals and to assist in the analysis of billing compliance patterns throughout the health system.
  • Continuously monitors federal and research-oriented agencies/organizations to stay current on new rules, regulations and revisions and educates other research staff with the changes concerning research billing compliance.
  • Establishes and maintains an exceptional professional working relationship with the Clinical Research Coordinators and staff, Principal Investigators, Patient Financial Services, Compliance and Internal Audit Department, other research and clinical care staff, and external parties involved with the process to ensure accurate documentation, coding, charging and billing for all services provided related to research or clinical trial billing.

Qualifications

  • Bachelors Degree in finance, business or related course of study.
  • 3 - 5 years of recent experience in clinical billing, finance, accounting, or coding (preferably research-related)Is knowledgeable and complies with institutional research and billing policies, procedures and guidelines, as well as governmental regulations regarding responsible conduct of research, research ethics and integrity, and protection of the safety and welfare of human subjects (including DHHS, FDA, and IRB regulations, HIPAA privacy and research regulations and others as apply to certain types of research such as specimen banks, genetic research, etc.).
  • Instructs less experienced personnel and advises others to ensure that research is conducted safely and in compliance with the above. Reports apparent or potential problems to Human Research Protections Program Manager.
  • Maintains established policies and procedures and quality assessment.  Maintains subject-matter expertise and enhances professional growth and development through participation in educational programs, current literature, in-service meetings, and workshops
  • .Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
  • Preferred Education - Masters Degree in finance, business or related course of study.

Licensure, Certifications, and Clearances:
Clearances must be dated within 5 years

  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance with renewal

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

COVID-19 Vaccination Information

Individuals hired into this role must comply with UPMC’s COVID vaccination requirements upon beginning employment with UPMC. Refer to the COVID-19 Vaccination Information section at the top of this page to learn more.

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct