We are hiring a Research Billing and Compliance Specialist in Nashville, TN.

Responsibilities

1. Review clinical research protocols, informed consent forms, and study budgets to determine appropriate billing requirements for research-related services.
2. Conduct coverage analysis to distinguish routine clinical care costs from research-related costs and identify services eligible for insurance billing versus sponsor or grant funding.
3. Develop, review, and maintain research billing grids and calendars to ensure accurate allocation of study-related procedures, tests, and services.
4. Ensure compliance with Medicare Clinical Trial Policy, National Coverage Determination (NCD) 310.1, applicable Local Coverage Determinations (LCDs), and other relevant payer requirements.
5. Review clinical trial claims and patient charges to identify potential billing errors, duplicate billing, incorrect payer assignments, and inappropriate charges.
6. Coordinate with clinical research coordinators, principal investigators, research finance teams, patient financial services, and clinical departments to resolve billing and compliance discrepancies.
7. Verify that clinical trial registration, qualifying clinical trial requirements, and supporting documentation are in place when required for Medicare or other payer coverage.
8. Monitor research-related services, procedures, and diagnostic tests against the approved protocol, coverage analysis, and study budget to ensure accurate charge allocation.
9. Conduct periodic research billing audits to identify compliance risks, assess adherence to institutional policies, and recommend corrective actions.
10. Investigate billing discrepancies, prepare audit findings, track corrective and preventive action plans (CAPAs), and support resolution of identified compliance issues.
11. Maintain accurate documentation of coverage analyses, billing determinations, audit trails, regulatory approvals, and research billing compliance records.
12. Review clinical trial budgets, sponsor agreements, and payment terms to ensure research services are billed appropriately and costs are not improperly charged to patients or third-party payers.
13. Provide education and guidance to research teams and billing staff regarding research billing compliance, payer requirements, documentation standards, and institutional policies.
14. Collaborate with compliance, legal, revenue cycle, and research administration teams to support internal audits, external reviews, payer inquiries, and regulatory investigations.
15. Monitor changes in federal regulations, payer policies, and institutional research billing procedures, and implement process improvements to strengthen compliance, reduce financial risk, and support audit readiness.
16. Assists with developing and implementing compliance and financial audits of clinical research.
    • Creates and maintains the reporting, education, and training for research billing compliance.
    • Develops processes to transmit and coordinate billing information through regulatory and compliance teams.
    Assists in reviewing financial records, contracts, and other information necessary to ensure compliance with billing
    requirements.
    • The responsibilities listed are a general overview of the position and additional duties may be assigned.

Required Skills

• 2+ years of Financial billing and reconciliation experience within Oncology
• Bachelors Degree
• Ability to work independently and in a hybrid setting
• Knowledge of compliance 

Preferred Skills

• Experience within an oncology research practice doing billing and compliance
• Has worked hybrid previously

Schedule/Shift

Monday-Friday 8am-4pm

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

^*As a job position within our Clinical Sciences division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: high-risk working environments (laboratories, clinical settings), handling hazards chemicals or lab specimens, conducting direct patient care, accessing medical and confidential records, access to prescription medication or other drugs, and job duties that can cause serious injury or death as a result of error. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.