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.