Mission Statement
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Job Summary
The Intermediate Research Billing Compliance Specialist serves as a key operational contributor responsible for the accurate review, adjudication, and processing of clinical research charges. Reporting to the Manager of Revenue Cycle Research Compliance, this role supports daily research billing compliance activities through the execution of charge review, and reconciliation in alignment with Coverage Analysis determinations, study billing grids, institutional policies, and applicable federal research billing regulations.
This position requires a working knowledge of revenue cycle processes, clinical trial billing requirements, and system applications, including MiChart and OnCore. The Intermediate Specialist collaborates closely with research teams, billing partners, and compliance staff to ensure accurate charge routing, appropriate documentation to support compliant billing, and timely resolution of issues. The role emphasizes transactional accuracy, quality assurance, and efficient resolution of routine research billing discrepancies, with escalation of complex or non-standard items as needed.
The Intermediate Specialist is responsible for reviewing charges for patients enrolled in clinical research studies in accordance with Medicare (CMS) and other third-party payer guidelines, as well as Clinical Trial Agreements (CTAs). This includes managing work queues, resolving charge and claim edits, and addressing denials to ensure accurate and timely billing to study accounts, third-party payers, and patients.
Responsibilities*
Details and Responsibilities:
Charge Review & Billing Accuracy
- Analyze and perform complex daily review of hospital and/or professional charges for clinical trials generated across all hospital ordering systems to make determinations on charge segregation of items and services using the coverage analysis (CA) billing grid and other medical documentation.
- Ensure research charges are routed accurately with appropriate modifiers, diagnoses, and documentation to support compliant billing.
Denials Management & Issue Resolution
- Partner with revenue cycle billing to resolve research-related denials.
- Escalate complex or non-standard billing issues to Senior/Lead staff as appropriate.
Compliance & Regulatory Adherence
- Responsible for identifying variances between the hospital and professional billing entries against required charge routing based on the Coverage Analysis.
- Ensure compliance with all Michigan Medicine clinical research billing policies and procedures. Know, understand, incorporate, and demonstrate the core mission and values of Michigan Medicine in all practices.
- Maintain an up-to-date understanding of Medicare's Clinical Trial Policy (NCD 310.1) and newly issued guidance, FDA regulations, and applicable federal and state statutes.
Stakeholder Support & Communication
- Respond to research billing inquiries from study teams and other research staff.
- Collaborate with internal stakeholders to support accurate and compliant research billing practices
Required Qualifications*
- Associates Degree in Business, Finance, Health Information Management, or a related field; or equivalent experience/certifications.
- Minimum of three years of experience in a healthcare revenue cycle or clinical operations role, with experience in healthcare compliance, general healthcare billing, research billing, or research billing compliance
- Knowledge of CMS billing rules and regulations such as National Coverage Determinations, Local Coverage Determinations, and specifically the Clinical Trial Policy (NCD 310.1).
- Familiarity with CPT/HCPCS coding and hospital billing (UB-04/1500).
- Experience with electronic health record systems.
Desired Qualifications*
- Bachelors Degree in Business, Finance or Healthcare field with a minimum of five years experience in professional and hospital billing, facility coding process and/or reimbursement experience, including familiarity with the functions and compliance concerns related to revenue cycle activities.
- ACRP/SoCRA (or equivalent) certification preferred.
- Familiarity with government websites, and/or non-government websites and any other information systems needed during detailed review is expected.
- Knowledge of University of Michigan and UMHS policies, procedures as well as regulatory requirements.
- Proficient with MiChart, knowledge of IRB process, E-Research, Clinical Trial Protocols, OnCore and compliance.
- Strong analytical, organizational, and problem-solving skills.
- Demonstrated ability to meet or exceed institutional goals and priorities in a fast-paced, high volume workload environment.
Why Join Michigan Medicine?
Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. Michigan Medicine is comprised of over 30,000 employees and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world?s most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at Michigan Medicine and become a victor for the greater good.
What Benefits can you Look Forward to?
- Excellent medical, dental and vision coverage effective on your very first day
- 2:1 Match on retirement savings
Modes of Work
Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about the work modes.
Background Screening
Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.
Application Deadline
Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled any time after the minimum posting period has ended.
U-M EEO Statement
The University of Michigan is an equal employment opportunity employer.