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Sanford Health Senior Research Coverage Specialist - Research in Sioux Falls, South Dakota

Job Title: Senior Research Coverage Specialist | Research | Sioux Falls

City: Sioux Falls

State: SD

Department : Clinical Research Services Administration - Sioux Falls

Job Schedule: Full Time

Shift: Days

Hours Per Shift: 8 hr


Coordinates, completes and documents processes for compliant research billing, contracts and related budget management. Completes aforementioned tasks with critical thinking and problem-solving skills. Identifies risks and seeks opportunities to solve issues early in the process. Creates Coverage Analyses (CAs) for all studies that involve human subjects' research to ensure compliance with laws, rules and regulations for coding and billing, including review of study protocols and budgets originating with Pharma partners, the NCI Community Oncology Research Program (NCORP) and Sanford Investigator-Initiated Research. Provides quality assurance checks for externally completed Coverage Analyses. Assists Research IT with completion of patent study calendar builds within the Sanford Research Clinical Trial Management System, Velos. Presents approved Coverage Analysis to Sanford Research Business Compliance Team for review and approval. In addition, reviews research claims billed through the electronic health records system to ensure consistency with approved coverage analyses. Reviews Electronic Privacy Information Center (EPIC) claims, ensuring research-specific coding requirements are attached. Investigates billing discrepancies and initiates related contractual updates. Conducts billing audits and provides support for other internal or external auditors. Investigates and resolves compliance issues related to the healthcare environment and clinical trial billing. Evaluates regulatory agency reports, formulating corrective responses and corrective actions. Creates and maintains logs, indexes, files, computer databases and other records pertaining to clinical trial billing compliance and risk.


Uses effective decision-making approaches such as consultative, command, or consensus. Separates essential facts from peripheral or supporting facts in a body of information. Seeks new and/or nontraditional ideas to improve personal and team effectiveness. Seeks discrepancies and inconsistencies in available information; explains variances. Prioritizes constantly while maintaining well-defined goals. Organizes potential problem solvers and leads problem resolution efforts. Evaluates and makes contributions to best practices. Documents how results were obtained to support knowledge transfer and best practices. Demonstrates an ability to adapt to continuous change in work demands. Contributes significantly to the well-being of team members and the larger community. Adapts documents and presentations for the intended audience.


This position will support the billing area of Research. This position will prepare Medicare coverage analysis, determining whether or not the trial is able to be billed to Medicare or other insurance. This position will review Medicare regulations and share information regarding coverage. This position will also review coding in EPIC to ensure procedure is properly coded as a trial. This position also assists with budgetary documents and makes changes as needed.

The successful candidate will have a strong attention to detail and be able to communicate with staff, providers and research sponsors. We are seeking someone with a coding, patient financial services or finance background.


Bachelor's degree required.

Minimum of five years' experience in clinical research, coding or clinical trial billing preferred.

About Sanford Health:

At Sanford Health, we are dedicated to the work of health and healing.

Every day, we show that commitment by delivering the highest quality of care to the communities we serve.

We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities.

In addition to strong clinical care, we are also committed to research, education and community growth.

We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases.

We continuously seek new ways to achieve our vision of improving the human condition here in your community, across the region and around the world.

The entire team at Sanford Health recognizes the value of healthy families and communities.

We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.

Sanford is an EEO/AA Employer M/F/Disability/Vet.

If you are an individual with a disability and would like to request an accommodation for help with your online application,

please call 1-877-673-0854 or send an email to .

City: Sioux Falls

State: SD

Job Function: Research

Job Schedule: Full Time

Shift: Days

Req Number: WD04319