Division Patient Access Services Lead - Authorization Denials

Patient Access Specialist Lead, Authorization Denials

The University of Texas MD Anderson Cancer Center is one of the world's leading cancer centers, dedicated to eliminating cancer through exceptional patient care, groundbreaking research, prevention, and education. Within the Radiation Therapeutic Services department, this role supports critical revenue cycle and patient access operations by ensuring accurate insurance authorizations, minimizing authorization-related denials, and promoting payer compliance across radiation therapy services.

The Patient Access Specialist Lead, Authorization Denials serves as the department's subject matter expert for denial management, payer requirements, and complex authorization workflows. The Patient Access Specialist Lead, Authorization Denials collaborates with operational, clinical, and revenue cycle stakeholders to protect organizational revenue while improving authorization quality and staff performance. The Patient Access Specialist Lead, Authorization Denials also provides mentorship, training, and escalation support to Patient Access staff while driving process improvements and denial prevention initiatives.

The ideal candidate will possess a Bachelor's Degree in Business, Healthcare Administration, or a related field, along with extensive experience in healthcare, insurance, patient access, authorization processing, denial management, and appeals. Candidates with strong knowledge of insurance verification, authorization requirements, CPT and diagnosis codes, explanation of benefits review, payer policy interpretation, and revenue cycle operations will be particularly successful. No certifications are required or preferred for this role.

Minimum $29.09/hour – Midpoint $36.30/hour – Maximum $43.51/hour

Why Us?
At UT MD Anderson, this position plays a vital role in protecting revenue integrity while supporting patients' access to life-saving cancer treatment. The role offers opportunities to develop expertise in revenue cycle operations, payer relations, denial management, and leadership while contributing to an organization recognized globally for excellence in cancer care, research, education, and prevention. Employees benefit from professional development opportunities, meaningful work, and comprehensive benefits that support both career growth and work-life balance.
• 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

Authorization Denial Management & Revenue Protection
• Serve as the Authorization Denial Liaison for Radiation Therapeutic Services and provide supporting documentation for appeals and claim resubmissions
• Research, analyze, and resolve authorization-related denials to protect organizational revenue
• Collaborate with Patient Business Services, Revenue Cycle teams, clinical teams, payers, and denial coordinators to investigate and resolve denials
• Perform root cause analysis of authorization denials and implement corrective action plans to prevent recurrence
• Maintain expertise in payer guidelines, authorization requirements, billing and coding practices, and denial management strategies
• Serve as the departmental subject matter expert for authorization denials, payer policy interpretation, and complex payer requirements

Training, Mentorship & Staff Development
• Develop and deliver training programs focused on authorization accuracy, denial prevention, and payer compliance
• Serve as the primary trainer and onboarding resource for new Patient Access staff
• Ensure staff competency in authorization workflows, payer requirements, and documentation standards
• Provide ongoing guidance, mentorship, and support for complex authorization scenarios and denial resolution strategies
• Assist staff with payer escalations and challenging authorization requirements

Insurance & Financial Authorization Management
• Verify insurance eligibility and benefits for patients receiving services
• Process insurance authorization requests for high-complexity Evicore cases
• Review cost estimates for completeness and accuracy prior to patient financial counseling and collections activities
• Communicate with insurance companies to resolve authorization barriers and obtain required supporting documentation
• Provide backup coverage for Lead Patient Access Specialist responsibilities across designated service lines and treatment modalities
• Support continuity of operations and timely financial clearance processes

Coordination, Escalation & Operational Support
• Serve as the primary escalation resource for complex authorization, denial, and payer-related issues
• Coordinate with Revenue Cycle, Patient Business Services, Clinical Teams, and Denial Coordinators to resolve urgent concerns
• Manage escalations through appropriate leadership channels to ensure timely resolution and communication
• Support departmental authorization quality and compliance initiatives
• Participate in institutional workgroups and continuing education activities to remain current on payer requirements

Data Analysis & Process Improvement
• Analyze denial and operational trend data to identify process improvement opportunities
• Recommend corrective actions to leadership based on denial trends and root cause findings
• Support implementation of workflow enhancements that improve authorization accuracy and reduce denials
• Contribute to revenue protection strategies through proactive denial prevention efforts 

EDUCATION

• Required: Associate's Degree Business, Healthcare or related field.
• Preferred: Bachelor's Degree Business, Healthcare Administration or related field.

WORK EXPERIENCE

• Required: 5 years Experience in healthcare, insurance or related field
• May substitute required education degree with additional years of equivalent experience on a one to one basis.
• Preferred: Previous experience with handling denials and/or appeals, experience and patient access knowledge dealing with insurance verification/authorization process, cpt/dx codes, explanation of benefits.

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 

Job Details
Employment Status: Full-Time
Organization: EVP & Chief Clinical Ops Ofc 710377
Employee Status: Regular
Work Locations: Houston (TX Med Ctr), 1515 Holcombe Boulevard, Houston, 77030
Work Location: Remote
Job Code: 01999
Salary (Pay Basis): 60,500.00
Salary Midpoint: 75500
Salary Maximum: 90,500.00
Fund Type: Hard
Work Week: Days
FLSA: exempt and not eligible for overtime pay