Because we all have a role
in making care exceptional
Director Medicare Coverage Analysis
Req#: 339909
Location:
Facilities: Main Campus
Professional Area: Administrative and Business Professionals
Job Code: T97706
Schedule: Full Time
Shift: Days
Apply Today!
Director Research Medicare Coverage Analysis
Join Cleveland Clinic’s Main Campus where research and surgery are advanced, technology is leading-edge, patient care is world-class, and caregivers are family. Cleveland Clinic is recognized as one of the top hospitals in the country. You will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.
Research is a big part of the mission of the Cleveland Clinic. This position will work collaboratively with the institutes and research billing office to create a Medicare coverage analysis billing grid for research studies with a patient care billing component. This is a high-level position to ensure compliance with research billing and mitigate our risks of improper billing and will help standardize the process for coverage analysis for the Cleveland Clinic.
A caregiver in this position works 8:00am—5:00pm.
A caregiver who excels in this role will:
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Manage and operate all administrative functions performed by the research Medicare coverage analysis team.
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Serve as the subject matter expert for the MCA Office and is responsible for determining qualifying clinical trial status and performing detailed coverage analysis as required by NCD 310.1 and the Federal Clinical Trials Policy (CTP).
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Ensure research billing practices are compliant by reviewing clinical trial protocols and related regulatory documents and agreements.
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Assist all patient care items and service required for each study protocol.
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Research and apply policies from various sources such as federal, state, CMS website, and professional practice guidelines in making coverage determinations.
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Document justification for coverage analysis by citing specific resources for coverage determinations.
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Direct the work activities of all research coverage analysts working in the section ensuring polices from various sources are followed.
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Interview, hire, orient, and train staff.
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Evaluate performance and provide feedback.
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Make personnel action recommendations (e.g., promotions, transfers, disciplinary, discharge)
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Review and approve MCA determinations performed by MCA analysts.
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Assist in managing claims review by applying the appropriate CDM and/or CPT codes for potentially billable items and services and identifying items and services billable to the research sponsor.
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Collaborate and communicate effectively as MCA subject matter expert with the Principal Investigator and research team, patient financial services, clinical research billing office, IRB, and research compliance related to Medicare coverage analysis issues and determinations.
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Keep current on FDA and Medicare regulations and state laws that apply to clinical trials research billing and trains MCA analysts.
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Generate policies and procedures related to Medicare coverage analysis for the Cleveland Clinic Health System.
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Develop tools and billing grids for the Medicare coverage analysis process.
Minimum qualifications for the ideal future caregiver include:
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Bachelor’s degree in healthcare administration, medical coding, auditing, finance, accounting, nursing, or a related field.
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Six years of clinical research experience and an additional four years of management experience (10 years’ experience total).
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Knowledge of billing compliance and Medicare regulations.
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Excellent oral and written communication skills and can effectively communicate as the MCA subject matter expert with the Principal Investigator, research team, central offices and study Sponsor.
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Interpret and comprehend complex clinical research protocols, interpret research contracts, study budgets and consent forms to extrapolate billing/coverage data.
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Strong organizational skills with ability to multi-task.
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Can manage high volume workload and meet established deadlines.
Preferred qualifications for the ideal future caregiver include:
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Master’s in business or healthcare administration.
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Overall experience and knowledge in coding with CPT.
Our caregivers continue to create the best outcomes for our patients across each of our facilities. Click the link and see how we’re dedicated to providing what matters most to you: https://jobs.clevelandclinic.org/benefits-2/
Physical Requirements:
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Ability to perform work in a stationary position for extended periods.
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Ability to operate a computer and other office equipment.
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Ability to communicate effectively and exchange accurate information.
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Ability to travel throughout the health system with occasional meetings with the Principal
Investigator and research teams and/or central offices.
Personal Protective Equipment:
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Follows standard precautions using personal protective equipment as required for procedures.
Pay Range
Minimum Annual Salary: $101,900.00
Maximum Annual Salary: $155,390.00
The pay range displayed on this job posting reflects the anticipated range for new hires. A successful candidate’s actual compensation will be determined after taking factors into consideration such as the candidate’s work history, experience, skill set and education. The pay range displayed does not include any applicable pay practices (e.g., shift differentials, overtime, etc.). The pay range does not include the value of Cleveland Clinic’s benefits package (e.g., healthcare, dental and vision benefits, retirement savings account contributions, etc.).
Application Process
At Cleveland Clinic, we strive to make your journey to becoming a contributing caregiver as streamlined as possible. Here’s how it works.
Step 1: Apply
You can begin the application process by clicking on the “Start Application” button below. We highly recommend that you apply with a resume so we can understand your professional background, including education, work and volunteer experience(s). When you apply, you will be required to answer a few Human Resources policy questions. Some positions require additional prescreening questions, including years of experience and specific questions related to the minimum qualifications of the job.
Step 2: Screening
A Cleveland Clinic caregiver will carefully review your application and notify you of the next steps in the process. This notification may be through email, text message or a phone call. In addition, you can expect to complete some prescreening questions with a recruiter or you may be asked to answer additional questions via a pre-recorded video interview.
Step 3: Interview
If qualified for the position, you will receive a text or email with the next steps. Potential next steps could include scheduling either a live, in-person interview or completing an on-demand, recorded interview. During the interview process, your recruiter will share information about when you can expect to receive any relevant feedback or information regarding potential next steps.
Step 4: Hire
If you are hired and accept an offer for the position you applied to, you will receive a formal offer letter to initiate the new hire onboarding process.
After you accept your formal offer letter, you can expect your recruiter to review the following information with you:
- Confirmation of HR and Occupational Health appointments, including the date, time, location and required pre-work for the appointments.
- A background check will be initiated by our third-party vendor, Certiphi.
- Any additional orientation information specific to your new position.
Nursing Support Career Paths
Working for Cleveland Clinic is more than just a job – it can be a launching point for an exceptional career. Nursing Support plays a critical role in ensuring excellent care and positive patient experiences. There is a wide range of roles to contribute to this vital team. We are committed to providing you with the resources and support you need to define and follow your own unique career path, whether in Nursing Support or other areas of our organization. Nursing Support opportunities include:
Our Culture
Exceptional patient care takes exceptional caregivers. We have created an environment where caregivers feel like family. It is a place noted for constant learning, intense collaboration and caring the right way for the right reasons. Here, you’ll take on every challenge with our unwavering support.
At Cleveland Clinic, we have made it our mission to care for life, research for health and educate those who serve. These principles have always been our North Star. And it has led us to deliver an exceptional level of care alongside some of the industry’s most gifted, hardworking caregivers. Our mission has also helped us define our vision: to be the best place to receive care anywhere and the best place to work in healthcare. In delivering care, we recognize four priorities:
- Care for patients as if they are your own family.
- Treat fellow caregivers as if they are your own family.
- Demonstrate commitment to the communities we serve.
- Treat the organization as your home.
Our unique working environment is built on a strong foundation of unifying beliefs that includes:
- Learning from experiences – We are a world-class hospital with a unique and varied caseload. Here, each moment is a new chance to be challenged, to learn and to grow as a caregiver. Browse our stories to see firsthand how experiences build experience.
- Developing our people – We are always learning. Our multi-disciplinary teams and knowledge-sharing allow our caregivers to be students of each other. Trainings, courses and mentorships round out our culture of learning. Our Career Growth Pathways is a suite of resources that helps caregivers enrich their current skill set, explore other roles, move laterally throughout the organization or grow vertically within their team. As they further their careers, caregivers can move into leadership roles in their discipline. Our Mandel Global Leadership & Learning Institute (GLLI) delivers experiential learning, simulations, assessments and research-driven content to help you progress into a leader.
- Caring for our caregivers – Our Office of Caregiver Experience (OCE) supports the emotional, physical, spiritual and social well-being of caregivers through multiple initiatives, resources and events.
Cleveland Clinic is an organization where we support one another, our patients and the communities we serve. It takes each of us to foster a sense of belonging and mutual respect. Together, we will continue to build a culture of excellence, supporting one another to feel empowered and valued. Cleveland Clinic remains committed to:
- Having a workforce, including our vendors and suppliers, that reflects the communities we serve – We do this without discrimination or preference based on race, sex or other similar factors.
- Following our hiring practices – This includes skills-based hiring, identifying robust and new talent sources and ensuring that adequate and equitable career pathways for advancement exist for all caregivers.
- Continuing our Employee Resource Groups (ERGs) – These important groups, open to all caregivers, offer an opportunity to relate to, grow with and support one another.
- Providing the most appropriate education to advance safe, highly reliable care – This includes support and programs that meet the unique needs of our patients and achieve the best possible outcomes.
We value your consistent dedication to exceptional patient care. We recognize and respect your life away from work. Being able to enjoy a fulfilling life can recharge you and enable you to be an even more effective contributor in your career. We are proud to provide a generous Paid Time Off (PTO) program for regular full-time, part-time and weekender benefits-eligible caregivers where they can accrue time off for vacations, holidays, sickness and personal days.
At Cleveland Clinic, we have made it our mission to care for life, research for health and educate those who serve. These principles have always been our North Star. And it has led us to deliver an exceptional level of care alongside some of the industry’s most gifted, hardworking caregivers. Our mission has also helped us define our vision: to be the best place to receive care anywhere and the best place to work in healthcare. In delivering care, we recognize four priorities:
- Care for patients as if they are your own family.
- Treat fellow caregivers as if they are your own family.
- Demonstrate commitment to the communities we serve.
- Treat the organization as your home.
Our unique working environment is built on a strong foundation of unifying beliefs that includes:
- Learning from experiences – We are a world-class hospital with a unique and varied caseload. Here, each moment is a new chance to be challenged, to learn and to grow as a caregiver. Browse our stories to see firsthand how experiences build experience.
- Developing our people – We are always learning. Our multi-disciplinary teams and knowledge-sharing allow our caregivers to be students of each other. Trainings, courses and mentorships round out our culture of learning. Our Career Growth Pathways is a suite of resources that helps caregivers enrich their current skill set, explore other roles, move laterally throughout the organization or grow vertically within their team. As they further their careers, caregivers can move into leadership roles in their discipline. Our Mandel Global Leadership & Learning Institute (GLLI) delivers experiential learning, simulations, assessments and research-driven content to help you progress into a leader.
- Caring for our caregivers – Our Office of Caregiver Experience (OCE) supports the emotional, physical, spiritual and social well-being of caregivers through multiple initiatives, resources and events.
Cleveland Clinic is an organization where we support one another, our patients and the communities we serve. It takes each of us to foster a sense of belonging and mutual respect. Together, we will continue to build a culture of excellence, supporting one another to feel empowered and valued. Cleveland Clinic remains committed to:
- Having a workforce, including our vendors and suppliers, that reflects the communities we serve – We do this without discrimination or preference based on race, sex or other similar factors.
- Following our hiring practices – This includes skills-based hiring, identifying robust and new talent sources and ensuring that adequate and equitable career pathways for advancement exist for all caregivers.
- Continuing our Employee Resource Groups (ERGs) – These important groups, open to all caregivers, offer an opportunity to relate to, grow with and support one another.
- Providing the most appropriate education to advance safe, highly reliable care – This includes support and programs that meet the unique needs of our patients and achieve the best possible outcomes.
We value your consistent dedication to exceptional patient care. We recognize and respect your life away from work. Being able to enjoy a fulfilling life can recharge you and enable you to be an even more effective contributor in your career. We are proud to provide a generous Paid Time Off (PTO) program for regular full-time, part-time and weekender benefits-eligible caregivers where they can accrue time off for vacations, holidays, sickness and personal days.
Benefits Offerings
Our caregivers deliver the best outcomes for our patients across each of our facilities. We are committed to providing them with the kind of exceptional care they bring to our patients. Caregivers like you come to work each day with a passion for what you do. So, we are always focused on fueling that passion, empowering you to be your best both inside our hospitals and in your life. Our outstanding, comprehensive offerings are an investment in your health, well-being and future. Explore the following benefits and get a closer look at how we’re focused on what matters most to you.
We offer the following choices to cover your health, dental and vision care as well as life insurance.
- Health Plan Options – You have the choice between two comprehensive Cleveland Clinic Employee Health Plan options: EHP and EHP Plus. Both plans are administered by Aetna and feature minimal copays for in-network care. Although the benefit designs of EHP and EHP Plus are identical, they differ in their provider network size, with EHP offering a narrow network and EHP Plus providing access to the wide Aetna Open Access Select network. Both plans include access to Cleveland Clinic providers. The health plan also offers Healthy Choice, a voluntary program where participants earn premium discounts for achieving wellness goals.
- Dental Care – Four plan options administered by Cigna are available.
- Vision Care – Two plan options administered by EyeMed are available.
- Flexible Spending Accounts – Healthcare and Dependent Care FSAs are available to help you pay for eligible expenses with pre-tax dollars.
- Life Insurance – Employer-paid life insurance equals 1x your annual salary with an option to purchase supplemental life insurance up to 10x your salary. You may also purchase dependent life insurance for a spouse and dependent children
- Short- and Long-term Disability Coverage – Short-term disability is available after one continuous year of regular full-time service; long-term disability begins after 90 days.
Because financial security is essential to a secure retirement, we sponsor a comprehensive retirement program to help you build for your financial future:
- Cleveland Clinic Investment Pension Plan offers eligible employees an excellent opportunity to build a retirement account for the future. It is fully funded by Cleveland Clinic and equal to 2.5% of your salary (increasing with more years of service).
- The 401(k) / 403(b) Plan also provides an important source of retirement savings. It allows participants to take responsibility for their financial future by making retirement savings a part of their normal routine while working. In addition to your contributions to the plan, Cleveland Clinic matches a portion of your contributions (50% on up to your first 6% in contributions).
- Paid Time Off (PTO) – Eligible caregivers receive Paid Time Off (PTO) that can be allotted toward vacation, holidays, sick time, etc.
- Caregiver discounts – We offer discounted rates for auto, home and pet insurance, identify theft protection and more.
- Adoption assistance – We provide financial assistance of up to $5,000/per child ($10,000 maximum lifetime benefit) for caregivers who choose to legally adopt a child.
- Employee Assistance Program – The Program provides free, confidential short-term counseling for caregivers and their families, whether for relationships or legal challenges.
- Employee Hardship Fund – This fund provides aid for caregivers experiencing unexpected financial difficulties.
- Paid maternity and parental leave – You will enjoy up to eight consecutive weeks for maternal care after the birth of your child to bond with your baby and up to four weeks for parental care.
We offer the following choices to cover your health, dental and vision care as well as life insurance.
- Health Plan Options – You have the choice between two comprehensive Cleveland Clinic Employee Health Plan options: EHP and EHP Plus. Both plans are administered by Aetna and feature minimal copays for in-network care. Although the benefit designs of EHP and EHP Plus are identical, they differ in their provider network size, with EHP offering a narrow network and EHP Plus providing access to the wide Aetna Open Access Select network. Both plans include access to Cleveland Clinic providers. The health plan also offers Healthy Choice, a voluntary program where participants earn premium discounts for achieving wellness goals.
- Dental Care – Four plan options administered by Cigna are available.
- Vision Care – Two plan options administered by EyeMed are available.
- Flexible Spending Accounts – Healthcare and Dependent Care FSAs are available to help you pay for eligible expenses with pre-tax dollars.
- Life Insurance – Employer-paid life insurance equals 1x your annual salary with an option to purchase supplemental life insurance up to 10x your salary. You may also purchase dependent life insurance for a spouse and dependent children
- Short- and Long-term Disability Coverage – Short-term disability is available after one continuous year of regular full-time service; long-term disability begins after 90 days.
Because financial security is essential to a secure retirement, we sponsor a comprehensive retirement program to help you build for your financial future:
- Cleveland Clinic Investment Pension Plan offers eligible employees an excellent opportunity to build a retirement account for the future. It is fully funded by Cleveland Clinic and equal to 2.5% of your salary (increasing with more years of service).
- The 401(k) / 403(b) Plan also provides an important source of retirement savings. It allows participants to take responsibility for their financial future by making retirement savings a part of their normal routine while working. In addition to your contributions to the plan, Cleveland Clinic matches a portion of your contributions (50% on up to your first 6% in contributions).
- Paid Time Off (PTO) – Eligible caregivers receive Paid Time Off (PTO) that can be allotted toward vacation, holidays, sick time, etc.
- Caregiver discounts – We offer discounted rates for auto, home and pet insurance, identify theft protection and more.
- Adoption assistance – We provide financial assistance of up to $5,000/per child ($10,000 maximum lifetime benefit) for caregivers who choose to legally adopt a child.
- Employee Assistance Program – The Program provides free, confidential short-term counseling for caregivers and their families, whether for relationships or legal challenges.
- Employee Hardship Fund – This fund provides aid for caregivers experiencing unexpected financial difficulties.
- Paid maternity and parental leave – You will enjoy up to eight consecutive weeks for maternal care after the birth of your child to bond with your baby and up to four weeks for parental care.
Ohio
Whether it’s in our hometown of Cleveland, throughout surrounding counties or across the state, we offer abundant opportunities all around Ohio. This includes both hospitals and outpatient facilities. Ohio features an incredible diversity of lifestyle options – from up-and-coming neighborhoods to historic suburbs and big-city excitement to small-town charm. Grab a bite, catch a game or enjoy the vibrant outdoors — you’ll never run out of things to do. Ohio also boasts a robust economy, excellent schools, affordable housing and much more.
Caregiver Stories
We all have an important story to tell. Our shared passions and experiences connect us and inspire us to be our best.
RN Pivots Toward Imaging Role After Several Semesters
After beginning her healthcare journey in nursing school, Ashley Bush discovered her interests were leading her elsewhere and ultimately found her calling in imaging through Cleveland Clinic’s training opportunities. Now working as an Interventional Vascular Technologist, she thrives in a fast-paced, team-based environment where every shift brings new challenges, continuous learning, and the chance to help restore patients’ blood flow in real time.
For Clinical Engineer, a Rapid Rise from Technician to Supervisor
Ryan Dickson, Clinical Engineering Supervisor at Cleveland Clinic Main Campus, plays a vital role in hospital clinical engineering by leading teams that repair, maintain, and troubleshoot critical medical equipment during live procedures. After starting as an intern and advancing from clinical technician to supervisor in less than seven years, Ryan’s career highlights the strong clinical engineering career growth, hands-on training, and healthcare technology opportunities available at Cleveland Clinic.
Join our Community!
Creating a profile in Cleveland Clinic’s Talent Community will allow our recruitment team to support your job search and identify the right opportunities for you. We will send out email job alerts and upcoming events based on your individual career background and objectives.
Please click below and complete the form to opt in to our Talent Community.
The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances.
Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.
Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.
If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration: https://info.flclearinghouse.com/
Please review the Equal Employment Opportunity poster.
Cleveland Clinic is pleased to be an Equal Employment Opportunity employer.