Clinical Auditor Jobs in Arizona

INTRODUCTION

Find your path in health care. We want to change the lives of those in our care – and the people who choose to take on this challenge. If you’re ready to change lives, we want to hear from you.

As a Senior Clinical Research Financial Analyst, you will play a critical role in ensuring the financial integrity and compliance of clinical research studies. Your primary responsibilities include analyzing insurance coverage requirements and payor policies to maintain study billing compliance, developing detailed cost projections for new and modified research studies, and building comprehensive clinical trial budgets. You will collaborate closely with research partners, internal teams, and external sponsors to negotiate favorable terms, finalize budget agreements, and ensure the financial feasibility of research projects. The preferred candidate should have experience working in clinical trials, with exposure to clinical trial budgets and payor coverage analysis.

SCHEDULE: This is a full-time remote position, scheduled Monday-Friday, 8AM-5PM. You must be local to Banner Alzheimer's Institute (1114 E McDowell Rd, Phx, AZ).

Banner Alzheimer's Institute (BAI) was established in 2006 as Banner Health's first Center of Excellence. Banner Sun Health Research Institute (BSHRI) was founded in 1986. Our team is uniquely, passionately, and strategically committed to ending Alzheimer's disease and other neurodegenerative disorders without losing another generation, advancing oncology research to improve cancer prevention and treatment outcomes, and providing an unparalleled model of care for families facing these devastating diseases. Banner Research is committed to improving people's lives through comprehensive patient care and advances that capitalize on the best biomedical research. We intend to make a transformational difference in Alzheimer's disease, other neurodegenerative disorders, and oncology research and care.

Position Summary

This position provides pre-initiation research study evaluation including cost, coverage, and overall financial benefit analysis. Ensures analytical evaluations provide relevant and complete measures of cost, revenue, and billing projections and processing. Ensures regulatory compliance and financial coverage. Develops and maintains effective project relationships. Translates medical service priorities into effective research development activities and support allocations to ensure research leads to desired outcomes consistent with organizational goals.

CORE FUNCTIONS

1. Completes Cost and Coverage Analysis. Completes CCA for all BH research studies utilizing clinical skills, good clinical practices and knowledge of research and government regulations to evaluate each new study and determine appropriate coverage and billing requirements. Serves as a knowledgeable consultant to guide other personnel on the determinations of what patient care items and services are considered standard of care. Creates study budget for any and all research activity occurring within a BH facility to accurately determine relevant costs associated with all research activity. Negotiates study budget, with study Sponsor integrating Medicare Coverage rules and allowances into contract to ensure proper reimbursement and study billing requirements are met. Assesses study financial risk/benefit ratio.

2. Ensures regulatory compliance and financial coverage. Ensures compliance with required federal, state, funding source, and other applicable governing entities regarding regulations, laws, and statutes governing the scope of research activity. Accesses the Clinical Trials Management System to obtain names of human subjects to ensure that research related charges are billed appropriately. Acts as a liaison between finance departments, patient financial services, facility research directors and system reimbursement services for the purpose of communicating information regarding the National Coverage Decision for clinical trials and other federal research regulations. Serves as a resource and provides leadership assistance for research participants; asks questions regarding financial coverage issues to ensure service excellence.

3. Performs for cause and random patient account audits to ensure compliance.

4. Develops and maintains effective project relationships. Coordinates closely with Banner Research and University of Arizona staff in the study approval process; meets project timelines and department goals of optimal clinical, operational, financial and satisfaction outcomes. Interacts with sponsors, physicians, colleagues, facility administrators, facility CFOs and patient financial services to ensure effective communication and project coordination. Translates medical service priorities into effective research development activities and support allocations to ensure research leads to desired outcomes consistent with organizational goals. Leads and administers research projects by promoting research and collegiality between physician investigators, staff, facility administrators, and department heads. Leads, facilitates and or participates in task forces or councils to plan, implement and coordinate programs and/or activities for the organization.

5. This position is responsible for evaluating approximately 100 new study proposals per year with a research budget in excess of $3 million. Negotiates study budget, integrating Medicare Coverage rules and allowances into contract to ensure proper reimbursement and study billing requirements are met. Translates medical service priorities into effective research development activities and support allocations to ensure research leads to desired outcomes consistent with organizational goals.

MINIMUM QUALIFICATIONS

Bachelor’s degree in business or healthcare related field or an equivalent combination of education and experience.

Three to five years related experience working directly with clinical research charge review and billing, coverage analysis, and clinical trials budgeting and negotiations. Proven analytical and modeling skills. Working knowledge of computer spreadsheets and other computer applications.

PREFERRED QUALIFICATIONS

Proven working knowledge of medical terminology and experience with CPT, HCPCS, ICD10 codes as they relate to clinical research billing. Experience utilizing a Clinical Trials Management System.

Additional related education and/or experience preferred.

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