Komen Graduate Training Program UT MDACC · 14 hours ago
Denials Management Coordinator
Houston, TX
Full-time
Hybrid
Mid, Senior Level
$89K/yr - $133K/yr
5+ years expKomen Graduate Training Program UT MDACC is seeking a Denials Management Coordinator to support MD Anderson's revenue cycle by coordinating the review, analysis, and resolution of insurance claim denials. The role involves utilizing clinical expertise and insurance knowledge to analyze patient accounts and invoices, ensuring accurate and timely reimbursement.
Hospital & Health Care
Responsibilities
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
Qualification
Required
Graduation from an accredited school of nursing
5 years Experience in clinical nursing
1 year Experience in utilization review
RN - Registered Nurse - State Licensure State of Texas Professional Nursing License (RN). Upon Hire
BLS - Basic Life Support Upon Hire or
CPR - Cardiac Pulmonary Resuscitation Upon Hire
Preferred
Bachelor's Degree Nursing
CM - Case Management Upon Hire
ACLS - Advanced Cardiac Life Support Certification as required by patient care area. Upon Hire
PALS - Pediatric Advanced Life Support Certification as required by patient care area. Upon Hire
Benefits
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
Medical, dental, paid time off , retirement , tuition benefits, educational opportunities, and individual and team recognition
Company
Komen Graduate Training Program UT MDACC
Through generous funding from Susan G.
11-50 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase