[Hiring] Denials Management Coordinator @UT MD Anderson Cancer Center

Role Description

The Denials Management Coordinator plays a vital role in supporting the organization’s revenue cycle operations by coordinating the review, analysis, and resolution of insurance claim denials to help ensure accurate and timely reimbursement. This role involves:

• Analyzing complex patient accounts, denied claims, audits, and appeals.
• Serving as a liaison between internal stakeholders and third-party payers.
• Identifying denial trends and facilitating retrospective approvals.
• Improving reimbursement outcomes through effective communication and clinical expertise.

Qualifications

• Registered Nurse with a Bachelor’s Degree in Nursing preferred.
• Experience with front-end and back-end insurance appeals, nurse auditing, utilization review, case management, or business office operations.
• Strong knowledge of insurance appeals, medical necessity reviews, and reimbursement processes.

Requirements

• Minimum $89,000 annually – Midpoint $111,000 annually – Maximum $133,000 annually (based on a 40-hour work week).
• Typical work schedule is Monday – Friday 8am – 5pm (must be able to come onsite as needed).
• Work Location: Remote (must be able to come onsite as needed).

Benefits

• Employer-paid medical coverage starting day one for employees working 30+ hours/week, plus optional group dental, vision, life, AD&D, and disability insurance.
• Accruals for PTO and Extended Illness Bank, plus paid holidays, wellness, childcare, and other leave options.
• Tuition Assistance Program after six months of service and access to extensive wellness, fitness, and employee resource groups.
• Defined-benefit pension through the Teachers Retirement System, voluntary retirement plans, and employer-paid life and reduced salary protection programs.

Responsibilities

• Denials Analysis & Appeals:
  • Analyze invoices and patient accounts in the patient accounting system to prepare appeals for third-party payer denials.
  • Utilize Explanation of Benefits (EOB) and Remittance Advices to verify denials and identify appeal opportunities.
  • Review denied services for retrospective approval, continued access needs, retrospective review, and defense audits.
  • Identify and evaluate denial trends that impact reimbursement and revenue cycle performance.
• Payer Communication & Resolution:
  • Contact third-party payers, insurance medical directors, case management, and utilization review teams to request reconsideration and appeals.
  • Provide comprehensive clinical and financial documentation to support appeal requests.
  • Coordinate appeal and audit activities and maintain timely follow-up on appealed or audited claims.
  • Communicate issues affecting future care needs and contract performance to leadership.
• Clinical & Revenue Cycle Collaboration:
  • Collaborate with Case Management and providers to ensure all medical necessity documentation is captured.
  • Serve as a liaison between clinical departments, coding, billing, payer relations, and financial teams.
  • Promote compliant revenue practices and support accurate reimbursement processes.
  • Support resolution strategies for complex denials requiring clinical intervention.
• Documentation & System Management:
  • Update and maintain patient accounting system information, including insurance, demographics, notations, and service codes.
  • Accurately document appeal activities, audit outcomes, and account actions.
  • Maintain confidentiality and follow hospital and departmental policies and procedures.
  • Perform business office responsibilities with minimal supervision while exercising sound judgment.
• Compliance & Professional Knowledge:
  • Demonstrate knowledge of third-party payer claim requirements, UB04, HCFA1500, EOBs, and appeal timelines.
  • Maintain understanding of insurance guidelines related to medical necessity review, including M&R and InterQual.
  • Apply working knowledge of ICD-10 and CPT codes.
  • Stay current on oncology clinical processes, outcomes, clinical trials, and related resources.
  • Contribute ideas and recommendations that improve revenue recovery and team effectiveness.

Education

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

Work Experience

• Required: 5 years Experience in clinical nursing.
• Required: 1 year Experience in utilization review.
• Preferred: Experience with front-end or back-end appeals, insurance appeals, prior case management, nurse auditing, or business office experience.
• 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.
• Required: BLS - Basic Life Support Upon Hire or 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.