Qureos Mentor

MD Anderson Cancer Center

<div>
 As a
 
 Nurse Defense Auditor
 
 in our
 
 Hospital Billing &amp; Collections
 
 department, your expertise ensures accurate reimbursement and supports patient access to life-saving care. This role combines clinical knowledge, insurance expertise, and critical thinking to resolve complex denials and audits-making a direct impact on patient outcomes and organizational success.
 
 
 MD Anderson offers our employees:
 
 
 <ul>
 <li>
 Paid Medical Benefits for employees and eligible dependents
 </li>
 <li>
 Generous Paid Time Off (PTO) for work-life balance
 </li>
 <li>
 Retirement Plans with employer contributions
 </li>
 <li>
 Career Development Opportunities and tuition assistance
 </li>
 <li>
 Additional perks such as wellness programs, employee discounts, and more
 
 
 </li>
 </ul>
 The primary purpose of the
 
 Nurse Defense Audit Coordinator
 
 position within the
 
 Hospital Billing &amp; 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 continued access needs. This role also includes conducting retrospective reviews and audits of patient accounts to complete Defense Audits.
 
 
 
 Ideal Candidate:
 
 A
 
 Registered Nurse (RN)
 
 with experience in
 
 appeals
 
 and
 
 nurse defense auditing
 
 .
 
 
 
 Key Functions
 
 
 
 <ul>
 <li>
 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.
 </li>
 <li>
 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.
 </li>
 <li>
 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 outside auditors.
 </li>
 <li>
 Collaborate with Case Management and providers to ensure all medical necessity documentation is captured.
 </li>
 <li>
 Coordinate appeal or audit processes and maintain appropriate follow-up on appealed/audited claims.
 </li>
 <li>
 Update and document patient accounting system accurately and efficiently, including insurance, demographics, notations, and service codes.
 </li>
 <li>
 Communicate with leadership regarding issues impacting future care needs and contract performance.
 </li>
 <li>
 Demonstrate thorough knowledge of third-party payer claim requirements, UB04, HCFA1500, EOBs, and appeal timelines.
 </li>
 <li>
 Maintain understanding of insurance guidelines for medical necessity review, including M&amp;R and InterQual, and working knowledge of ICD-10 and CPT codes.
 </li>
 <li>
 Stay current on oncology clinical processes and outcomes, including clinical trials and related resources.
 </li>
 <li>
 Perform related business office responsibilities with minimal supervision, demonstrating innovation, good judgment, and adherence to ethical and legal billing procedures.
 </li>
 <li>
 Follow hospital and department policies and maintain confidentiality in all matters.
 </li>
 <li>
 Actively contribute to a team approach, offering positive suggestions and ideas for improved revenue recovery and team success.
 
 
 </li>
 </ul>
 
 EDUCATION
 
 
 
 <ul>
 <li>
 Required: Graduation from an accredited school of nursing.
 </li>
 <li>
 Preferred: Bachelor's Degree Nursing.
 
 
 </li>
 </ul>
 
 Work Experience
 
 
 
 <ul>
 <li>
 Required: 5 years Experience in clinical nursing and 1 year Experience in utilization review.
 </li>
 <li>
 May substitute preferred degree for two years of the five clinical nursing experience.
 </li>
 <li>
 Preferred: Nurse Defense Audit experience, experience with insurance appeals, prior case management or business office experience.
 
 
 </li>
 </ul>
 
 Work Schedule
 
 : This position is remote. Prefer Houston/local area.
 
 
 
 LICENSES AND CERTIFICATIONS
 
 
 
 <ul>
 <li>
 Required: RN - Registered Nurse - State Licensure State of Texas Professional Nursing License (RN). Upon Hire and
 </li>
 <li>
 Required: BLS - Basic Life Support Upon Hire or
 </li>
 <li>
 Required: CPR - Cardiac Pulmonary Resuscitation Upon Hire
 </li>
 <li>
 Preferred: CM - Case Management Upon Hire
 </li>
 <li>
 Preferred: ACLS - Advanced Cardiac Life Support Certification as required by patient care area. Upon Hire
 </li>
 <li>
 Preferred: PALS - Pediatric Advanced Life Support Certification as required by patient care area. Upon Hire
 
 
 </li>
 </ul>
 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.http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html
 
 
 Additional Information
 
 
 <ul>
 <li>
 Requisition ID: 177616
 </li>
 <li>
 Employment Status: Full-Time
 </li>
 <li>
 Employee Status: Regular
 </li>
 <li>
 Work Week: Days
 </li>
 <li>
 Minimum Salary: US Dollar (USD) 89,000
 </li>
 <li>
 Midpoint Salary: US Dollar (USD) 111,000
 </li>
 <li>
 Maximum Salary : US Dollar (USD) 133,000
 </li>
 <li>
 FLSA: exempt and not eligible for overtime pay
 </li>
 <li>
 Fund Type: Hard
 </li>
 <li>
 Work Location: Remote (within Texas only)
 </li>
 <li>
 Pivotal Position: Yes
 </li>
 <li>
 Referral Bonus Available?: No
 </li>
 <li>
 Relocation Assistance Available?: No
 </li>
 </ul>
</div>

Nurse Defense Auditor

<div>The Point of Care Laboratory at MD Anderson plays a critical role in delivering rapid, accurate diagnostic testing directly where patient care happens. Our team supports clinicians across the institution by ensuring high-quality point-of-care results that enable timely clinical decisions, improve workflows, and enhance patient safety. Working in this fast-paced, high-impact environment, Point of Care Laboratory professionals contribute to seamless operations and uphold the standards that make MD Anderson a global leader in cancer care. 
 
As a Medical Laboratory Scientist in the Point of Care Laboratory, you'll perform a wide range of testing, maintain and troubleshoot equipment, ensure regulatory compliance, and support quality oversight for decentralized testing sites across the institution. This role is ideal for MLS professionals who enjoy autonomy, problem-solving, and collaborating with clinical teams across diverse care settings. You will also contribute to process improvements, participate in validation of new tests and devices, and assist with training and mentoring, strengthening support structures that directly enhance patient care outcomes. 
 
MD Anderson is proud to offer a comprehensive benefits package, including paid medical benefits, PTO, retirement plans, and more, ensuring you have the support you need to grow your career while maintaining balance in your personal life. 
 
**The hours for this position are Monday - Friday 2:30pm-11pm with rotating weekends (once a month) and holidays. The ideal candidate will have a bachelors degree in a science related field** 
 
JOB SPECIFIC COMPETENCIES 
 
Performs all laboratory testing specific to the assigned section 
<ul><li>
Remains knowledgeable and competent in all policies, procedures, and protocols</li><li>
Ensures and verifies that quality control data is appropriate for the complexity of reported tests; prepares corrective actions as needed</li><li>
Troubleshoots and maintains laboratory equipment</li><li>
Validates and evaluates new methodologies and tests; sets up connectivity with assistance from technical support</li><li>
Follows section inventory control systems to ensure effective use of supplies and reagents</li><li>
Completes, verifies, and reports testing in a timely manner</li><li>
Complies with safety guidelines and procedures; adheres to all regulatory mandates</li><li>
Remains responsible and accountable for all actions</li></ul> 

Performs Call Center duties 
<ul><li>
Answers incoming calls to the laboratory regarding sample testing status for Core Laboratory tests</li><li>
Provides specimen collection requirements for divisional tests</li><li>
Reports critical values, vitals, and nursing calls to healthcare providers for microbiology, chemistry, and hematology results</li><li>
Manages customer service interactions with diplomacy, resolving problems and addressing needs of internal and external clients</li></ul> 

Administrative &amp; Technical Support 
<ul><li>
Maintains proficiency in Microsoft Office to independently prepare laboratory reports</li><li>
Properly enters specimen data into computer systems</li><li>
Analyzes and evaluates patient results correctly and appropriately</li><li>
Stores patient information and results for easy future access as required</li></ul> 

Enhances productivity and laboratory functions 
<ul><li>
Adjusts, prioritizes, and organizes work to meet workload demands efficiently</li><li>
Assists peers, senior/lead medical laboratory scientists, and supervisors after completing assigned work</li><li>
Adheres to attendance policies and begins work as scheduled</li><li>
Works independently and uses available resources to maximize efficiency</li></ul> 

Assists in development of laboratory personnel and tests 
<ul><li>
Participates in process improvement projects</li><li>
Performs and monitors Quality Checks for laboratory devices, including IQCP requirements</li><li>
Validates databases for new software or new laboratory tests</li><li>
Coaches and mentors students and employees</li></ul> 

Other duties as assigned 
 
EDUCATION
 
<ul><li>Required: Associate's Degree Laboratory Science or Medical Laboratory Technology or Bachelor's Degree Related science field or Molecular Genetic Technology or Successful completion of a National Accrediting Agency for Clinical Laboratory Science (NAACLS) accredited Clinical Laboratory Science/Molecular Genetic Technology accredited program.
</li></ul> 
WORK EXPERIENCE
 
<ul><li>Required: 2 years Clinical laboratory experience with Associate's degree in Laboratory Science or Medical Laboratory Technology. 1 year Clinical laboratory experience with Bachelor's degree in a related science field or no experience required with completion of a National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) accredited Clinical Laboratory Science/Molecular Genetic Technology accredited program.
</li></ul> 
LICENSES AND CERTIFICATIONS
 
<ul><li>Preferred: ASCP - American Society of Clinical Pathologist Technologist/Scientist/Specialist certification or CHS - Certified Histocompatibility Specialist American College of Histocompatibilty &amp; Immunogenetics (ACHI) or CHT - Certified Histocompatability Technologist American College of Histocompatibilty &amp; Immunogenetics (ACHI) or MDT - Molecular Diagnostics Tech American Medical Technologists (AMT) or MT - Medical Technologist American Medical Technologists (AMT).
 
 
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.http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html</li></ul> 
Additional Information
 
<ul><li>Requisition ID: 177692
</li><li>Employment Status: Full-Time
</li><li>Employee Status: Regular
</li><li>Work Week: Evenings, Rotating, Weekends
</li><li>Minimum Salary: US Dollar (USD) 67,000
</li><li>Midpoint Salary: US Dollar (USD) 83,500
</li><li>Maximum Salary : US Dollar (USD) 100,000
</li><li>FLSA: non-exempt and eligible for overtime pay
</li><li>Fund Type: Hard
</li><li>Work Location: Onsite
</li><li>Pivotal Position: Yes
</li><li>Referral Bonus Available?: Yes
</li><li>Relocation Assistance Available?: Yes
</li></ul> 
#LI-Onsite</div>

Medical Laboratory Scientist - Point of Care - Evenings

<div>The Employee Health &amp; Well-being department supports employee well-being through programs such as the Employee Assistance Program (EAP), Caring Fund, and Occupational Health. These services provide confidential counseling, financial assistance, and health resources to employees, ensuring a safe and supportive work environment. The team collaborates across multiple units to deliver high-quality care and operational excellence. 
 
The primary purpose of this position is to coordinate administrative and operational activities for EAP, Caring Fund, and Occupational Health programs. This role manages workflows, budgets, and reporting while ensuring timely and accurate service delivery. The position requires strong organizational skills, technical proficiency, and the ability to work collaboratively across multiple teams. 
 
The ideal candidate holds a bachelor's degree in Human Resources, Business Administration, or a related field, with at least two years of professional HR or administrative experience. A master's degree may substitute for experience. They are highly skilled in project coordination, data analysis, and Microsoft applications, including Excel and PowerBI. Familiarity with Kronos, Concur, PeopleSoft Financial, and occupational health software such as Cority is preferred. Strong organizational, communication, and multitasking abilities are essential. 
 
The typical work schedule is Monday - Friday, 7:30 AM - 4:30 PM standard business hours, with occasional flexibility based on departmental needs. 
 
Hourly breakdown of salary range: Minimum $29.08 - Midpoint $36.29 - Maximum $43.50 
 
What's in it for you: 
<ul><li>
Employer-paid medical coverage starting day one for employees working 30+ hours/week, plus optional group dental, vision, life, AD&amp;D, and disability insurance.</li><li>
Accruals for PTO and Extended Illness Bank, plus paid holidays, wellness, childcare, and other leave options.</li><li>
Tuition Assistance Program after six months of service and access to extensive wellness, fitness, and employee resource groups.</li><li>
Defined-benefit pension through the Teachers Retirement System, voluntary retirement plans, and employer-paid life and reduced salary protection programs.</li></ul> 

Job Description: 
<ul><li>
Coordinate administrative and operational activities for EAP, Caring Fund, and Occupational Health programs.</li><li>
Develop and monitor project budgets, milestones, and deadlines.</li><li>
Prepare reports and oversee program communications to ensure compliance with institutional standards.</li><li>
Conduct quality improvement reviews and implement process enhancements.</li><li>
Manage confidential files and ensure accurate data entry into case management systems.</li><li>
Initiate and monitor Caring Fund applications, including eligibility review and case tracking.</li><li>
Provide administrative support for travel requests, purchasing, and timekeeping systems.</li><li>
Serve as a superuser for occupational health software (Cority), including troubleshooting and user training.</li><li>
Assist with report preparation, website updates, and formatting for annual and ad hoc reports.</li><li>
Perform additional administrative duties as assigned, including front office support and record maintenance. Bilingual 
Occupational Health Applications 
Microsoft Excel
 
Serves as a superuser for the occupational health (EAP) software application (Medgate/Cority). Duties include but not limited to, assisting in the preparation of audit reports, update to data look-up tables, creation of business rules within the application, troubleshoot and resolve initial performance issues, and provide basic user training 
</li></ul> 
 
EDUCATION 
<ul><li>
Required: Bachelor's Degree Human Resources, Business Administration or related field.</li><li>
Preferred: Master's Degree Human Resources, Business Administration or related field.</li></ul> 

WORK EXPERIENCE 
<ul><li>
Required: 2 years Professional human resources experience. or</li><li>
Required: No experience required with Master's degree.</li><li>
May substitute required education degree with additional years of equivalent experience on a one to one basis.</li></ul> 
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.http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html 
 
Additional Information
 
<ul><li>Requisition ID: 177694
</li><li>Employment Status: Full-Time
</li><li>Employee Status: Regular
</li><li>Work Week: Days
</li><li>Minimum Salary: US Dollar (USD) 60,500
</li><li>Midpoint Salary: US Dollar (USD) 75,500
</li><li>Maximum Salary : US Dollar (USD) 90,500
</li><li>FLSA: non-exempt and eligible for overtime pay
</li><li>Fund Type: Hard
</li><li>Work Location: Hybrid Onsite/Remote
</li><li>Pivotal Position: No
</li><li>Referral Bonus Available?: No
</li><li>Relocation Assistance Available?: No
</li></ul> 
#LI-Hybrid</div>

Human Resources Representative

Join MD Anderson Cancer Center and explore 3   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

MD Anderson Cancer Center

ABOUT_COMPANY

Nurse Defense Auditor

Medical Laboratory Scientist - Point of Care - Evenings

Human Resources Representative