Clinical Trials Billing Specialist

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A Brief Overview

The billing specialist will facilitate accurate billing for patients enrolled in clinical trials in accordance with federal regulations to reduce both institutional and individual provider legal and financial risk. They will ensure that both professional and hospital claims include correct identifiers and are compliant with government regulations with special attention to CMS guidelines as they pertain to billing for patients enrolled in clinical trials. In conjunction with Clinical Trials Financial Management who handles the first tier, this role will serve as the second tier review for the two-tier billing process to confirm charges will be routed to the appropriate funding source based on the linked clinical trial protocol in both Epic and OnCore (CTMS system). 

Why This Role Is Exciting

• Critical to Discovery: Play a key role in ensuring the accuracy and integrity of clinical trial billing — the foundation that keeps CHOP’s research enterprise running smoothly.

• Impact: This role plays a critical part in ensuring clinical trial billing compliance and supporting a strong revenue cycle. By validating that research-related charges are billed with the appropriate clinical trial identifiers, the team helps prevent denials, improves first-pass claim resolution, and reduces financial risk. Their work strengthens regulatory compliance, addresses gaps identified through prior audits, and helps ensure accurate reimbursement for both research and patient care services.

What You Bring

• Knowledge of clinical trial billing review processes
• Ability to interpret clinical trial protocols in Epic and OnCore
• Experience with clinical trial claim edits and identifiers
• Ability to identify and resolve research-related billing denials
• Strong attention to detail and regulatory compliance knowledge
• Effective analytical and problem-solving skills

Work Environment & Flexibility

• Hybrid Preferred, Remote Option: Core work hours are 8am-5pm, Monday to Friday. Tuesdays are onsite at the Cira Centre in Philadelphia if within a commutable distance

• Purposeful Connection: As a part of the Hospital Billing and Collections team, under Patient Financial Services, departmental meetings and workshops aid in collaboration between functions

• Optional Onsite Support: Preferred for fostering collaboration and supporting operational needs as a team.

What you will do

• Acts as subject matter expert in their department, manages projects to timely completion, troubleshoots issues and maintains accurate and compliant workflows.
• Holds inter-departmental relationships within PFS and outside of PFS; manages assigned workflows and work queues associated with these relationships and is the primary communicator with the department for any improvement opportunities.
• Monitors work queues assigned as their responsibility, meeting established production and quality standards for the assigned tasks.
• Specific focus is project oriented. Identify trends, training opportunities, denial prevention initiatives and maintaining internal controls for the department.
• Performs workflow analysis, documents workflows, and testing planning in support of departments strategic and operational objectives.
• Stays current on regulations and industry standard trends to ensure CHOP is compliant.
• Responsible for creating presentation and data analytics to drive change and improvements.
• Documents processes to help keep revenue cycle stakeholders informed and identify optimization opportunities.
• Other duties as assigned.

Education Qualifications

• High School Diploma / GED Required
• Bachelor's Degree Preferred

Experience Qualifications

• At least three (3) years of work experience in healthcare billing or collections environment or other related role. Required
• Demonstrated success in resolution of patient accounts; demonstrated ability to identify trends and complete assignments timely Required
• At least one (1) year of coding experience Preferred

Skills and Abilities

• Strong math aptitude (Required proficiency)
• Excellent organizational skills. (Required proficiency)
• Clear and concise decision making skills (Required proficiency)
• Leadership skills (Required proficiency)
• Detail oriented (Required proficiency)
• String interpersonal skills (Required proficiency)
• Excellent writing and oral communication skills (Required proficiency)
• Ability to work independently; results oriented (Required proficiency)
• Ability to handle confidential matters. (Required proficiency)
• Flexibility to work overtime as needed/required (Required proficiency)
• Experience with personal computers including Excel (Required proficiency)
• Experience with Epic system (Preferred proficiency)

Licenses and Certifications

• Certified Coding Specialist (CCS) - AAPC, AHIMA - upon hire - Preferred or
• Certified Coding Specialist-Physician-Based (CCS-P) - AAPC, AHIMA - upon hire - Preferred or
• Certified Professional Coder (CPC) - AAPC, AHIMA - upon hire - Preferred or
• Certified Professional Coder Apprentice (CPC-A) - AAPC, AHIMA - upon hire - Preferred

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must receive an annual influenza vaccine. Learn more.
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SALARY RANGE:

Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.

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At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOP's Compensation and Benefits.