Denials Management Coordinator

As a Denials Management Coordinator in our Hospital Billing & Collections department is to utilize one's clinical expertise, insurance knowledge, business know-how, and high level communication to analyze patient accounts and invoices to assist in the resolution for retrospective approval for denied services and possibly continued access needs or retrospective review and audit patient accounts and to complete a Defense Audit.

The primary purpose of the Denials Management Coordinator supports MD Anderson's revenue cycle by coordinating the review, analysis, and resolution of insurance claim denials to ensure accurate and timely reimbursement. This position serves as a key liaison between clinical departments, coding, billing, payer relations, and financial teams to identify denial trends, prevent future denials, and promote compliant revenue practices.

The ideal Candidate will be a Registered Nurse (RN) with experience in appeals, whether they are front-end and back-end appeals, and nurse auditing experience. This candidate understands insurance appeals, prior case management, or business office experience.
Shift Hours: Monday - Friday 8am - 5pm(must be able to come onsite as needed).

MD Anderson offers our employees:
• Paid Medical Benefits for employees and eligible dependents
• Generous Paid Time Off (PTO) for work-life balance
• Retirement Plans with employer contributions
• Career Development Opportunities and tuition assistance
• Additional perks such as wellness programs, employee discounts, and more

Key Functions

• Analyze invoices and accounts in the patient accounting system to prepare for appeals of third-party payer denials. Utilize Explanation of Benefits (EOB) and Remittance Advices to verify denials and identify possible avenues of appeal.
• Contact third-party payers, insurance medical directors, case management, and utilization review to request reconsideration and/or appeal of claims requiring clinical intervention, ensuring comprehensive data is provided to justify appeals.
• Collaborate with Case Management and providers to ensure all medical necessity documentation is captured.
• Coordinate appeal or audit processes and maintain appropriate follow-up on appealed/audited claims.
• Update and document patient accounting system accurately and efficiently, including insurance, demographics, notations, and service codes.
• Communicate with leadership regarding issues impacting future care needs and contract performance.
• Demonstrate thorough knowledge of third-party payer claim requirements, UB04, HCFA1500, EOBs, and appeal timelines.
• Maintain understanding of insurance guidelines for medical necessity review, including M&R and InterQual, and working knowledge of ICD-10 and CPT codes.
• Stay current on oncology clinical processes and outcomes, including clinical trials and related resources.
• Perform related business office responsibilities with minimal supervision, demonstrating innovation, good judgment, and adherence to ethical and legal billing procedures.
• Follow hospital and department policies and maintain confidentiality in all matters.
• Actively contribute to a team approach, offering positive suggestions and ideas for improved revenue recovery and team success.

EDUCATION

• Required: Graduation from an accredited school of nursing.
• Preferred: Bachelor's Degree Nursing.

WORK EXPERIENCE

• Required: 5 years Experience in clinical nursing. and
• Required: 1 year Experience in utilization review.
• : May substitute preferred degree for two years of the five clinical nursing experience.

LICENSES AND CERTIFICATIONS

• Required: RN - Registered Nurse - State Licensure State of Texas Professional Nursing License (RN). Upon Hire and
• Required: BLS - Basic Life Support Upon Hire or
• Required: CPR - Cardiac Pulmonary Resuscitation Upon Hire
• Preferred: CM - Case Management Upon Hire
• Preferred: ACLS - Advanced Cardiac Life Support Certification as required by patient care area. Upon Hire
• Preferred: PALS - Pediatric Advanced Life Support Certification as required by patient care area. Upon Hire

The University of Texas MD Anderson Cancer Center offers excellent benefits , including medical, dental, paid time off , retirement , tuition benefits, educational opportunities, and individual and team recognition.

This position may be responsible for maintaining the security and integrity of critical infrastructure, as defined in Section 113.001(2) of the Texas Business and Commerce Code and therefore may require routine reviews and screening. The ability to satisfy and maintain all requirements necessary to ensure the continued security and integrity of such infrastructure is a condition of hire and continued employment.

It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state, or local laws unless such distinction is required by law.

Additional Information

• Requisition ID: 178864
• Employment Status: Full-Time
• Employee Status: Regular
• Work Week: Days
• Minimum Salary: US Dollar (USD) 89,000
• Midpoint Salary: US Dollar (USD) 111,000
• Maximum Salary : US Dollar (USD) 133,000
• FLSA: exempt and not eligible for overtime pay
• Fund Type: Hard
• Work Location: Remote
• Pivotal Position: Yes
• Referral Bonus Available?: No
• Relocation Assistance Available?: No

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