Billing Compliance and Quality Control Specialist

** Job Description
**** The School of Medicine has an outstanding opportunity for a Program Operations Specialist to join their team.
** The University of Washington (UW) is proud to be one of the nation’s premier educational and research institutions. Our people are the most important asset in our pursuit of achieving excellence in education, research, and community service. Our staff not only enjoy outstanding benefits and professional growth opportunities, but also an environment noted for diversity, community involvement, intellectual excitement, artistic pursuits, and natural beauty.

UW Medicine works to improve the health of the public by advancing medical knowledge, providing outstanding primary and specialty medical care to people of the region, and preparing tomorrow’s physicians, scientists and other health professionals. Within the large UW Medicine health system, the School of Medicine (SOM) is a world leader in biomedical research, with the largest biomedical research program at a public university based on National Institutes of Health funding and ranking among the top research universities internationally.

The Clinical Trials Office (CTO) supports the clinical research mission of UW Medicine. The CTO is an operational unit within the SOM’s Office of Research and Graduate Education charged with providing multi-service support to clinical researchers bringing important new therapies to our patients in compliance with evolving regulatory requirements.

The Billing Compliance & QC Specialist will perform comprehensive and independent final compliance review (Summary Review) of all documents related to research study funding, including the research study budget, protocol, contractual terms, informed consent, and other supporting documentation.  The incumbent will additionally function as a subject matter expert with CTO production workflows and systems processes, and will offer suggestions for optimization strategies.

This position will assist with training internal staff on processes and systems and will educate CTO customers on workflows and expectations. Ability to work collaboratively in a group setting in a fast-paced environment is crucial in this role.

The Clinical Trials Office is a central clinical research operation with compliance responsibilities and services across the vast portfolio of clinical trials in UW Medicine. The CTO operation has direct impact on UW’s reputation with major global biotech and biopharma sponsors, the availability of funded clinical trial opportunities in the UW pipeline, and UW patients' access to novel therapies. In addition, the CTO plays a key role in mitigating institutional financial and reputational risks by ensuring strict compliance with CMS and FDA regulations and guidelines.

The Billing Compliance & QC Specialist is a key position in maintaining a secure and fully compliant CTO operation.
** DUTIES AND RESPONSIBILITIES
**** Workflow and Billing Compliance - 70%
*** Perform comprehensive and independent analysis of systems processes pertaining to CTO review workflows.
* Determine appropriate workflow pathway for proper routing of studies through the start-up process.
* Perform Pre-CTO Admin Tasks import process for study submissions.
* Perform Pre-Activation Checks for studies prior to transition to the CTO Billing Team for RSH Activation in Epic.
* Perform CTO Inbox Management functions in the Zendesk (ZD) Customer Service Management tool.
* Review and perform tasks from various Clinical Trial Management System (CTMS) OnCore reports, related to multiple workflows.
* Understand and exercise independent judgment and discretion in the interpretation and application of the Medicare Clinical Trial Policy, and all relevant UW Medicine clinical research budgeting and billing policies and procedures.
* Perform comprehensive and independent final compliance review (Summary Review) of all documents related to research study funding, including the research study budget, protocol, contractual terms, informed consent, and other supporting documentation.
* Review and finalize study Billing Grids, ensuring proper documentation of Coverage Analysis decisions.
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