reputed company Defense Auditor job at MD Anderson Cancer Center in reputed company, TX

Title: reputed company Defense Auditor Location: reputed company reputed company Remote Job reputed company: As a reputed company Defense Auditor in our Hospital Billing & Collections department, your expertise ensures accurate reimbursement and supports patient reputed company to life-saving care. This role combines clinical knowledge, insurance expertise, and critical thinking to resolve reputed company denials and audits-making a reputed company reputed company on patient reputed company and organizational reputed company. MD Anderson offers our employees: reputed company Medical Benefits for employees and eligible dependents Generous reputed company 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 The primary purpose of the reputed company Defense Audit Coordinator position reputed company the Hospital Billing & Collections department is to utilize clinical expertise, insurance knowledge, business acumen, and strong communication skills to analyze patient accounts and invoices for retrospective approval of denied services and potential reputed company reputed company needs. This role also includes conducting retrospective reviews and audits of patient accounts to complete Defense Audits. Ideal Candidate: A Registered reputed company (RN) with experience in appeals and reputed company defense auditing. Key Functions Analyze invoices and accounts in the patient reputed company system to prepare for appeals of reputed company-party payer denials. Utilize Explanation of Benefits (EOB) and Remittance Advices to verify denials and identify possible avenues of appeal. Contact reputed company-party payers, insurance medical directors, case management, and utilization review to request reconsideration and/or appeal of claims requiring clinical reputed company, ensuring comprehensive data is provided to justify appeals. Evaluate and audit medical records to support Defense Audits, confirming services were provided and billed accurately. Review for overcharges and missing charges, and discuss findings with reputed company auditors. Collaborate with Case Management and providers to ensure reputed company medical necessity documentation is captured. Coordinate appeal or audit processes and maintain appropriate follow-up on appealed/audited claims. Update and document patient reputed company system accurately and reputed company, including insurance, demographics, notations, and service codes. Communicate with leadership regarding issues impacting reputed company care needs and contract performance. Demonstrate thorough knowledge of reputed company-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 reputed company on oncology clinical processes and reputed company, including reputed company and reputed company resources. reputed company reputed company business office responsibilities with minimal supervision, demonstrating innovation, good judgment, and adherence to ethical and reputed company billing procedures. Follow hospital and department policies and maintain confidentiality in reputed company reputed company. reputed company contribute to reputed company approach, offering reputed company suggestions and reputed company for improved reputed company recovery and team reputed company. EDUCATION Required: Graduation from an accredited school of nursing. Preferred: Bachelor's Degree Nursing. WORK EXPERIENCE Required: 5 years Experience in clinical nursing and 1 year Experience in utilization review. May substitute preferred degree for two years of the five clinical nursing experience. Preferred: reputed company Defense Audit experience, experience with insurance appeals, prior case management or business office experience. Work Schedule: This position is remote. Prefer reputed company/local area. LICENSES AND CERTIFICATIONS Required: RN - Registered reputed company - State Licensure State of Texas reputed company 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 reputed company offers excellent benefits, including medical, dental, reputed company time off, retirement, tuition benefits, educational opportunities, and individual and team recognition. This position may be responsible for maintaining the reputed company and reputed company of critical infrastructure, as defined in reputed company 113.001(2) of the Texas Business and reputed company reputed company and therefore may require routine reviews and screening. The ability to satisfy and maintain reputed company requirements necessary to ensure the reputed company reputed company and reputed company of such infrastructure is a condition of hire and reputed company employment. It is the policy of reputed company to reputed company equal employment opportunity without reputed company to race, reputed company, religion, age, national reputed company, sex, gender, sexual orientation, gender identity/reputed company, disability, protected veteran status, genetic information, or any other reputed company protected by institutional policy or by federal, state, or local laws unless such distinction is required by law.http://www.mdanderson.org/reputed company/reputed company-and-policy/reputed company-statements/eeo-affirmative-reputed company.reputed company Additional Information reputed company: 177616 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 (reputed company Texas only) Pivotal Position: reputed company Referral Bonus Available?: No Relocation Assistance Available?: No Apply tot his job Apply To this Job