RCM Research Specialist

OneOncology is positioning community oncologists to drive the future of medical care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer and other diseases. Our team is bringing together leaders to the market place to help drive OneOncology’s mission and vision.

Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, urology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of independent physicians and the patients they serve.

Job Description:

JOB SUMMARY:

The RCM Research Specialist works under the direct supervision of the Medical Billing Manager and is responsible for reviewing clinical trial protocols to ensure compliance with practice requirements and payer policies. This position communicates with GHCR and Regimen teams regarding protocol changes and updates, develops and maintains non-billable grids for each protocol to support accurate billing, tracks patient enrollments, and provides reporting and operational support related to clinical trial enrollment and billing.

ESSENTIAL FUNCTIONS

• Review new or amended clinical trial protocols to ensure content meets practice requirements and payer policies.
• Return protocols to GHCR/OneR with applicable information for review and feedback.
• Review regimen builds for all clinical trial protocols in the EMR to ensure accurate billing of billable and non-billable services.
• Develop and maintain a non-billable grid for each protocol, including applicable footnotes to support billing and reporting.
• Create drug inventory custom research codes and distribute them to Billing for review and inclusion in claim edits.
• Coordinate with IT regarding setup of non-FDA-approved drugs within the EMR, Drug Inventory, and Practice Management Systems.
• Document new study protocol information, including study open and termination dates, in the Practice Management System.
• Maintain clinical trial protocol logs and tracking spreadsheets.
• Review protocol amendments, update non-billable grids, and communicate changes to Billing and other appropriate departments.
• Perform monthly comparisons of clinical trial enrollment figures, identify discrepancies, and make necessary corrections.
• Prepare and submit financial invoices to Accounting or OneR to support accurate billing.
• Prepare physician enrollment reports and distribute them to Accounting and Leadership.
• Maintain clinical trial enrollment information in the Practice Management System.
• Assist with clinical trial billing and protocol-related questions.
• Prepare monthly clinical trial reports and other reports as needed.
• Audit billing to ensure adherence to clinical trial billing guidelines.

KNOWLEDGE, SKILLS & ABILITIES:

• Knowledge of healthcare policies and procedures.
• Knowledge of contracts and utilization.
• Knowledge of computer systems, programs, and spreadsheet applications.
• Knowledge of medical terminology.
• Skill in gathering, analyzing, and reporting information.
• Strong problem-solving skills.
• Strong written and verbal communication skills.
• Professional telephone skills and etiquette.
• Ability to work effectively with minimal supervision.
• Ability to identify, analyze, and resolve claim-related problems.

EDUCATION & EXPERIENCE:

• High school diploma or General Education Development (GED) certificate required.
• Minimum of five (5) years of experience in healthcare or managed care
• Experience with statistical and financial analysis preferred
• Any prior experience with Clinical Trials preferred
• Proficiency with computer systems and Microsoft Office applications, including Outlook, Word, Excel, etc.