Research Billing Quality Review Analyst - Hybrid - 130902

UC San Diego Health's Revenue Cycle department supports the organization's mission to deliver outstanding patient care and to create a healthier world - one life at a time. We are a diverse, patient-focused, high-performing team with a commitment to quality, collaboration, and continuous improvement that enables us to deliver the maximum standard of care to our patients. We offer challenging career opportunities in a fast-paced and innovative environment and we embrace individuals who demonstrate a deep passion for problem-solving and customer service.

The Research Billing Quality Review Analyst oversees comprehensive audits of accounts with research charges submitted post-claim to Medicare, Medi-Cal, and Commercial insurance payers, as well as post-statement invoicing for research studies. Acting as the primary liaison to physicians, researchers, internal UCSD Health stakeholders, and patients, the incumbent ensures adherence to Medicare's Clinical Trial Policy, federal regulations, and contractual agreements with pharmaceutical and third-party entities. Additionally, the Specialist serves as a subject matter expert in research billing workflows and system processes, contributing optimization strategies.

Key Responsibilities:

• Collaborate with research clinical staff, Patient Financial Services (PFS), Patient Access, Health Information Management (HIM)/Coding, Physician Billing Group, and third parties to maintain compliance with clinical trial billing workflows.
• Offer guidance and serve as a resource on clinical trial regulations and best practices to internal and relevant external parties.
• Address internal department billing challenges and provide support at designated meetings to facilitate cross-departmental alignment.
• Conduct annual billing training for research staff and as-needed training for new hires.

In addition to conducting audits, the Research Billing Quality Review Analyst synthesizes regulations and industry publications, assisting in the development of training materials and other departmental guidance documents. Operating autonomously, the Specialist conducts regular, ad hoc, and for-cause audits to ensure compliance with applicable federal and state laws, regulations, guidance, and internal policies and procedures. Furthermore, the Specialist provides detailed reports of findings and contributes to the development of corrective and preventative action plans.

• Seven (7) years of related research billing audit experience, education/training, in an academic health system OR a Bachelor's degree in related area plus three (3) years of related research billing audit experience experience/training.

• Thorough knowledge of the practices, procedures, and concepts of the healthcare revenue cycle and its component operations, including billing, collections, charge capture, contractual adjustments, third-party reimbursements, and cash management.

• Thorough understanding of the issues, processes, reporting instruments, metrics, analytics, and other tools and techniques involved with measuring and analyzing the revenue cycle.

• Detail oriented, with proven ability to effectively manage time, see tasks and projects through to completion, organize competing priorities, and effectively address complex, urgent issues as they arise.

• Strong skills in report development, dashboard design, and various software tools specific to healthcare revenue cycle management. Skills in common database, spreadsheet and presentation software.

• Strong communications skills, with the ability to interpret and convey complex clinical finance information in a clear, concise manner. Ability to prepare compelling and informative reports and presentations.

• Strong analytical and problem-solving skills, with the ability to evaluate the effectiveness of workflows and systems and propose innovative solutions.

• Strong interpersonal skills, with the ability to collaborate effectively on complex projects in a team environment with staff from a wide variety of business and clinical areas.

• Proven ability to work with managers, serving as a technical resource, providing recommendations and advice on regulatory changes, and industry trends and developments in revenue cycle management.

• Lean Six Sigma Green Belt or higher for Healthcare.

• Coding certification (AAPC or AHIMA).

• Research compliance certification.

• Epic research billing certification.

• Velos CTMS experience.

• Must be able to work various hours and locations based on business needs.

• Employment is subject to a criminal background check and pre-employment physical.

If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements.

If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.

UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and and dozens of outpatient clinics. We invite you to join our team!

Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.

To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community.

UC San Diego is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.

For the University of California's Affirmative Action Policy please visit: https://policy.ucop.edu/doc/4010393/PPSM-20
For the University of California's Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination

UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.

UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.

Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

a. "Misconduct" means any violation of the policies or laws governing conduct at the applicant's previous place of employment, including, but not limited to, violations of policies or laws prohibiting sexual harassment, sexual assault, or other forms of harassment, discrimination, dishonesty, or unethical conduct, as defined by the employer. For reference, below are UC's policies addressing some forms of misconduct:

• UC Sexual Violence and Sexual Harassment Policy
• UC Anti-Discrimination Policy
• Abusive Conduct in the Workplace