Paige Johnson

Utilize Coverage Analysis (CA) to determine if patient care charges belong on routine care accounts that are billable to third party, or if charges are paid for by the study sponsor.

Responsible for all charge entry and edits using CA as a guide. Strong knowledge of Federal/State/Private payor general coverage principles, clinical trial policies, billing regulations and guidelines, and the Medicare July 2007 NDC Routine Costs in Clinical Trials (310.1) document.

Training of internal teams on the importance of billing charges per the CA to avoid Compliance issues. Able to identify risk trends in the billing continuum. Review and interpretation of trial protocols for budgeting and billing compliance purposes.

Support and educate all study team members on accurate CPT code selection and provide expert guidance on division specific CPT codes.

Own monthly billing statement generation and dispersal to study teams for approval. Processes all corrections and edits on statements. Maintains Journal Entry to Research Accounting to invoice sponsor.

Contact person for all AE’s and SAE’s within the institution.

Follows established institute and department policies, procedures, objectives, performance improvement, attendance, safety, environmental, and infection control guidelines, including adherence to the workplace Code of Conduct and Compliance Plan.

Handled all incoming requests for prior authorization and utilization review for pediatric at-risk population.

Close work with a dedicated team of clinical nurses, social workers, case managers, and utilization review nurses to determine appropriate need of services.

Managed all requests for home health care, enteral needs, medical supplies, Speech/Occupational/Physical Therapies, Pregnancy, and inpatient/Outpatient services.

Community outreach via programs for Health Literacy.

Processed all inpatient and outpatient (by clinic) authorizations for specific insurance carriers.

Maintained close relationship with all insurance entities accepted by the institute. Consistent updates for guidelines of determination of care.

Communicated daily with insurance companies to input patient benefits and note within patient accounts accordingly.

Registration of patients for upcoming procedures.