UCSD's Office of Coverage Analysis Administration (OCAA) is dedicated to ensuring billing compliance for clinical research. A coverage analysis ties together the clinical trials protocol, budget, contract and informed consent to determine what is billable to insurance based on federal/state billing regulations including Medicare's National Coverage Decision (NCD) 310.1 as well as other third-party billing rules. It ensures consistent application of Medicare rules across studies, and consistent application of study documents.

Under the general direction of the Director, this position is responsible for managing and executing the day-to-day operations of OCAA related to Coverage Analyses (CAs) and supervising the OCAA staff. Incumbent will provide analyses and make independent contributions for planning and development of OCAA. This includes review of research protocols and assessment to determine the billable nature of items and services provided in the context of clinical research. Incumbent will provide training to the CA Analysts and Campus departments on the coverage analysis process, perform operational process review and implementation, review the work of the CA Analysts to ensure Quality Assurance (QA), perform website administration, update and modify Standard Operating Procedures (SOPs), continually review metrics and track productivity and timelines. Incumbent will focus efforts on operationalizing clinical research efforts for OCAA.

Incumbent may perform coverage analyses that include the development of the coverage analysis (CA) grid and billing justifications of varying complexity with information provided by the Principal Investigators (PIs), Study Teams, and other departments (i.e. HRPP, OCTA, and OCGA) in compliance with UCSD policies. Incumbent must be extremely comfortable working with numerous databases and electronic information, able to quickly read and comprehend large amounts of scientific, medical, and legal text.

• Nine (9) years of related experience, education/training, OR a Bachelor's degree in related area plus five (5) years of related experience/training.

• Managerial experience and proven success in managing and leading a dynamic team of experienced and new analysts. Demonstrated knowledge of clinical research and interpreting and comprehending complex clinical research protocols, budget exhibits and informed consent forms.

• Possess excellent interpersonal skills including tact, diplomacy, flexibility, and professionalism in dealing with faculty, staff and industry representatives. Strong organization, communication, and customer service skills are required. Ability to maintain a professional manner in short fuse and time sensitive situations.

• Strong leadership skills with the ability to act independently and exercise sound judgment, with the acumen and sensitivity to identify those decisions and activities which require confidentiality and/or higher-level consultation and/or group collaboration.

• Strong supervisory skills and ability to direct others; Strong demonstrated ability to delegate, motivate, and evaluate employees. Demonstrated ability to recruit, train and supervise staff. Ability to establish and convey short- and long-term goals for assigned projects. Proven skill in promoting harmonious working relationships and working in a team environment. Experience in creating a positive team culture.

• Proven project management experience with the ability to participate in planning, organizing, analyzing, implementing and managing application of clinical research analyses involving multisite and priorities.

• Strong knowledge or Medicare coverage analyses, SB 37 and NCD 310.1 and other regulations relevant to clinical research.

• Demonstrated ability applying regulations to the billing of routine costs for clinical research.

• General knowledge of billing and coding for clinical care and research.

• Demonstrated knowledge and related experience to comprehend, interpret, and apply regulations to the billing of routine costs for clinical research.

• Employment is subject to a criminal background check.
• Must be willing and able to work occasional evenings and weekends based on business needs; travel to sites as necessary.