Coverage Analyst II

Company Information

At Advarra, we are passionate about making a difference in the world of clinical research and advancing human health. With a rich history rooted in ethical review services combined with innovative technology solutions and deep industry expertise, we are at the forefront of industry change. A market leader and pioneer, Advarra breaks the silos that impede clinical research, aligning patients, sites, sponsors, and CROs in a connected ecosystem to accelerate trials.

Company Culture

Our employees are the heart of Advarra. They are the key to our success and the driving force behind our mission and vision. Our values (Patient-Centric, Ethical, Quality Focused, Collaborative) guide our actions and decisions. Knowing the impact of our work on trial participants and patients, we act with urgency and purpose to advance clinical research so that people can live happier, healthier lives.

At Advarra, we seek to foster an inclusive and collaborative environment where everyone is treated with respect and diverse perspectives are embraced. Treating one another, our clients, and clinical trial participants with empathy and care are key tenets of our culture at Advarra; we are committed to creating a workplace where each employee is not only valued but empowered to thrive and make a meaningful impact.

Job Duties & Responsibilities

• Understand and interpret Clinical Research Protocols, Informed Consent Forms, Clinical Trial Agreements, and other relevant study-related documents to create a coverage analysis/billing guide.
• The coverage analysis indicates which medical procedures/services may be 'Routine Cost' and billable to patient/insurance and which should be billed to the study sponsor.
• Determines whether proposed clinical research studies are a Qualifying Clinical Trial as defined by the Medicare Clinical Trial Policy (NCD 310.1) and designates medical procedures/services based on relevant regulations and determinations.
• Research and apply policies, guidance, and guidelines from various sources, including federal and state regulations.
• Apply clinical guidelines, Medicare regulations, and institutional guidance of conventional care to independently determine which services are considered routine care.
• Work closely with the reporting manager to complete daily/weekly coverage analysis targets and meet the pre-determined quality criteria.
• Understand and utilize internal case management software and other reporting software to ensure that daily/weekly work assignments are appropriately completed.
• Documents and notates coverage analysis and associated documentation in the clinical trials management system.
• Actively participate in team meetings and contribute meaningfully to discussions related to specific customer cases and/or protocols.
• Train and mentor new team members on the coverage analysis processes, tools, and quality expectations to accelerate their learning curve and ensure consistent performance standards.
• Drive continuous improvement and knowledge sharing by identifying skill & knowledge gaps, lead focused training sessions and author internal documents or knowledge sharing articles to strengthen team capabilities and reduce recurring errors.

Basic Qualifications

• Bachelor’s or master’s degree in science with a background in Clinical Research or in similar domain.
• Sound knowledge of clinical research methodology, industry regulations and Good Clinical Practice guidelines related to human research.
• Expected to work independently, as well as in a team environment.
• Excellent organizational and administrative abilities.
• Familiarity with MS Office and various business software

Preferred Qualifications

• Excellent customer service skills.
• Ability to be flexible with working hours to collaborate with internal and external stakeholders.
• Identify opportunities for improvement and work proactively and collaboratively with a team to drive change.
• Excellent communication skills, including listening, writing and speaking.
• A passion for ensuring outstanding customer support with a solution-oriented attitude.
• Proficient in the use of Microsoft Word, Excel and PowerPoint.
• Preferred: 2-3 years’ work experience in job areas such as:
• Coverage Analysis
• Calendar and Budget set-up
• Clinical Trial Coordinator at Site
• Clinical Data Management
• Pharmacovigilance
• Medical Writing
• Medical Coding
• Any other relevant experience in similar domains

Physical and Mental Requirements

• Sit or stand for extended periods of time at stationary workstation
• Regularly carry, raise, and lower objects of up to 10 Lbs.
• Learn and comprehend basic instructions.
• Focus and attention to tasks and responsibilities.
• Verbal communication; listening and understanding, responding, and speaking.

Advarra is an equal opportunity employer that is committed to providing a workplace that is free from discrimination and harassment of any kind based on race, color, religion, creed, sex (including pregnancy, childbirth, and related medical conditions, sexual orientation, and gender identify), national origin, age, disability or genetic information or any other status or characteristic protected by federal, state, or local law.