Revenue Cycle Specialist – Clinical Research Billing

Revenue Cycle Specialist – Clinical Research BillingSeeking a Revenue Cycle Specialist to support Clinical Research Finance & Compliance operations with a focus on clinical trial patient billing and revenue cycle activities. This role will assist with a billing backlog by reviewing clinical trial patient charges and determining whether costs should remain on the patient account or be transferred to the appropriate research or study account.The ideal candidate will have experience interpreting clinical documentation, medical billing information, CPT codes, and treatment activity to ensure accurate billing practices. This is not strictly a coding role; success in this position requires an understanding of how clinical services, research protocols, and billing requirements intersect.Key ResponsibilitiesReview patient bills and claims associated with clinical trial participants.Evaluate charges to determine whether they should remain on the patient account or be transferred to a research/study account.Review patient charts and clinical documentation to validate services and treatments performed.Analyze clinical trial protocols and Medicare Coverage Analyses (MCA) to determine appropriate billing treatment.Apply Medicare Q0/Q1 research billing requirements when applicable.Utilize knowledge of CPT codes, medical billing processes, clinical procedures, and treatment workflows when evaluating charges.Maintain research billing information within electronic medical record and clinical trial management systems.Enter and update Medicare Coverage Analysis information within clinical trial systems.Support maintenance of research timelines and billing records.Participate in billing compliance reviews and audits for clinical trial participants.Assist with research chargemaster maintenance by comparing CPT codes charged against codes reflected in research budgets.Identify billing discrepancies and recommend appropriate corrections or process improvements.Collaborate with research finance teams, research coordinators, nursing program coordinators, investigators, and billing personnel.Assist with system testing, process improvement initiatives, reporting needs, and special projects.Work independently to make informed billing determinations based on clinical documentation, research protocols, Medicare guidelines, and standard treatment practices.Contribute to reducing billing backlog and improving overall turnaround times.Required QualificationsMinimum of 2 years of experience in healthcare with exposure to: Medical billing, Hospital billing, Clinical research, Revenue cycle operations, Medical coding, Related healthcare finance functions.Hands-on experience reviewing: Medical bills, Claims, Charges, Coding information.Working knowledge of: Medical billing processes, Clinical services and procedures, CPT coding concepts, Revenue cycle workflows.Ability to: Interpret patient charts and clinical documentation, Investigate discrepancies independently, Make sound decisions based on available documentation, Work across multiple systems and work queues, Manage detail-oriented assignments in a hybrid environment.Preferred QualificationsClinical trial billing or research billing experienceOncology or cancer-related billing experienceExperience reviewing Medicare Coverage Analyses (MCA)Knowledge of Medicare research billing requirements, including Q0/Q1 modifiersEpic experience, particularly within patient billing, claims, charges, or revenue cycle workflowsHospital or health system revenue cycle experienceMedical billing and coding experienceExperience working with CPT codes and chargemaster processesClinical background such as LPN or RN with an understanding of treatment workflows and billing implicationsRevenue cycle experience involving pre-certification, billing review, claims resolution, or denials managementCoding certification such as CCS or a similar credential (preferred, not required)Ideal Candidate ProfileThe strongest candidates will have a blend of clinical understanding and billing expertise, allowing them to connect patient care activities with appropriate revenue cycle outcomes.

Individuals who have worked within hospital systems, research environments, oncology programs, or complex billing operations will be especially successful in this role.