Grade: T27
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A variety of important factors are reviewed by HR when considering salary, including job duties, the applicant's education and experience, all relevant internal equity considerations, department budget, and funding source.

The Research Billing Specialist is responsible for adjudication of all charges for all subjects enrolled in clinical trials, for the Lewis Katz School of Medicine, based on Medicare Coverage rules and Clinical Trial contracts to ensure proper compliance and reimbursement. Engaged in proactive and independent line-item review of charge related items/encounters within Temple Health in collaboration with clinical research departments, while ensuring that performance metrics are at or above standardized levels.

The Specialist serves as the expert EPIC resource for Research Administration in LKSOM and acts as the conduit between all LKSOM research coordinators, LKSOM Research Administration and the EPIC Research Revenue Cycle Team based at Temple Health. Guides coordinators in the intricacies of enrolling and managing subjects in Oncore and the linkage of the Oncore subjects to EPIC. Works closely with the Oncore management team and Clinical Research Administrations Offices of Industry Contracts& Budgets group reviewing and applying Medicare Coverage Analysis; serves as expert resource for technical questions in budget negotiations with regard to clinical billing. Serves as the technical expert for complex research billing workflows, providing ongoing updates, and training to existing staff. Responsible for working account work queues, charge review edits, claim edits, etc. while ensuring the accuracy and completeness of all research-related charges within EPIC for accurate and timely billing to study accounts, insurance/Medicare, and/or the patient

The incumbent actively participates in internal audits, maintains documentation of current workflows, assists with special projects, and works closely with the Offices of Industry Contracts, Budgets & Oncore; Office of Clinical Research Operation & Regulatory Affairs; the Office of Clinical Research Operations in Thoracic Medicine & Surgery; IT; and EPIC Department. Participates in quality improvement initiatives to improve accounts receivable and improve accuracy and efficiency. In addition, the Specialist is the primary contact responsible for answering questions regarding team functions, accurate and timely processing of study-related charges and responding to any concerns/appeals of various research coordinators and payers. Stays current on regulatory requirements and ensure regulatory changes are incorporated into process and workflow.

Responsibilities include:
• Maintaining a complete portfolio of accounts receivable for area of expertise. This includes following accounts through the revenue cycle, from charge review, account work queues, claim edits, and claim submission. This includes:
o Resolving claim edits via claim edit work queues and/or our external billing software
o Reviewing charges daily that are in the Epic charge router review work queues, charge review work queues, and Epic generated reports to segregate them as standard-of-care services, research-related services, or indeterminate services
o Following federal and state regulations to ensure compliance standards are met
o Ensure that professional fees are adjusted the same way that technical fees are adjusted
o Will drive and coordinate processes to secure maximum revenue from study fees through timely and accurate billing and collection
• Verify patient coverage information and update registration as required
• Refer to study documents, study protocol, informed consent form, Clinical Trial Agreement (CTA) and budget to review new research patient accounts for patient care charges associated with each clinical research project on a regular basis utilizing the OnCore system
• Identifies appropriate use of billing modifiers and other CMS requirements for billing research-related charges to federal and non-federal payors
• Performs remediation of charge errors discovered during EPIC review
• Communicate with Revenue Cycle teams, payors, and others to resolve account problems; participate in meetings as needed to address any potential payor concerns
• Collaborates with the clinical research department administrators and study coordinators in the development and implementation of educational activities related to charge capture improvement projects
• Processes charge related corrections, additions, and removals in EPIC for both the hospital and physician billing to ensure organizational compliance with all state and federal regulations
• Involved in developing strategy for maximizing financial opportunities in the conduct of research through accurate and timely charge review
• Complete work on special projects, queries and reports as assigned
• Attends training classes, as determined by management
• Provide general assistance with team:
o Complete quality improvement and productivity activities
o Answer questions regarding team functions and assist with team direction
o Assist in training staff as needed

Performs other duties as assigned.

Employment at Temple University means much more than a competitive salary. Temple strives to maintain a culture of diversity and inclusivity and provide employees with opportunities for growth and advancement. You will enjoy a collaborative working environment that values innovation and creativity. Our health and wellness benefits are among the best in the region, and our retirement savings plans allow you to plan for the future. Temple University offers many opportunities for employees to enhance skills, gain new perspectives and grow professionally. For example, you can earn your bachelor's degree or an advanced degree through our tuition remission benefit or develop your management and leadership skills in one of our HR Learning and Development's academies. Temple University employees also enjoy recreational, entertainment, and cultural activities both on campus and throughout the Philadelphia region.

Click here to learn more about the benefits of working at Temple University.

Required Education & Experience:
Bachelor's Degree in Healthcare, Business, or a related field and three years of related experience in healthcare revenue cycle, clinical operations, and Epic billing. An equivalent combination of education and experience may be considered.

Required Skills & Abilities:
*Understanding of Medicare billing rules and functional knowledge of essential National Coverage Decisions and the new CMS Clinical Research Policy
*Knowledge of medical and insurance terminology, CPT, ICD coding structures, and billing forms (UB, 1500)
*Working knowledge of Epic and Oncore systems and MS Office
*Working knowledge of hospital charge capture flow
*Advanced analytic ability
*Strong attention to detail and ability to adhere to policies and procedures
*Ability to react to frequent changes in duties and volume of work
*Self-starter with willingness to try new ideas; positive, can-do attitude
*Ability to work urgently and independently while sustaining large volumes of work

Preferred:
* Knowledge of key research financial regulations regarding research (e.g., FDA / OHRP / ORI / DHHS / NIH)

This position requires a background check.

This position is assigned a hybrid work arrangement (on-campus and remote), the duration of this hybrid work arrangement is at the discretion of Temple University and the Department.

Temple University is committed to a policy of equal opportunity for all in every aspect of its operations, including employment, service, and educational programs. The University has pledged not to discriminate on the basis of age, color, disability, marital status, national origin or ethnic origin, race, religion, sex (including pregnancy), sexual orientation, gender identity, genetic information or veteran status.

Compliance Statement: In the performance of their functions as detailed in the position description employees have an obligation to avoid ethical, legal, financial and other conflicts of interest to ensure that their actions and outside activities do not conflict with their primary employment responsibilities at the institution. Employees are also expected to understand and be in compliance with applicable laws, University and employment policies and regulations, including NCAA regulations for areas and departments which their essential functions cause them to interact.

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Go here to review: https://safety.temple.edu/reports-logs/annual-security-report You may request a copy of the report by calling Temple University's Campus Safety Services at 215-204-7900.