Cook Children's Medical Center

Revenue Integrity Clinical Appeals Nurse (45328112)
Location: Fort Worth, Texas - United States
Posted: 2/13/2018

Revenue Integrity Clinical Appeals Nurse

Full-Time Days
Summary: Under the leadership of Patient Financial Services (PFS) management, the Revenue Integrity Clinical Appeals Nurse is responsible for assisting the Revenue Cycle Management team with identifying and preventing revenue leakage due to missing charges, Charge Master Descriptor issues, clinical denials, coding, contract management issues and etc. This position requires extensive knowledge of Federal, State, and payor regulations, reimbursement methodologies, and communication with third party payers to facilitate timely and accurate reimbursement. Perform root cause analysis and resolution of clinical denials.

Bachelors degree required.
Texas Registered Nurse License required. (BSN) - Bachelors of Science in Nursing preferred.
Registered Health Information Technician preferred
Certified Denials Recovery Specialist preferred
Certified Patient Account Manager preferred
Understanding of Managed Care contracts, denials and payor methodology
Extensive knowledge of healthcare third party reimbursement, variance and denial records
Effective oral and written communication skills
Keyboarding accuracy and math aptitude skills
Prior experience with Epic Hospital Billing Resolute preferred
The ideal candidate will have a minimum of 5 years' experience in a pediatric setting
Previous experience in one or more of the following areas preferred: case management, utilization management, clinical pathways, managed care and denials management in a healthcare business office setting.Licensure, Registration and/or Certification:

Current Texas RN license. CCM preferred

Additional Requirments / Information

Job Capacity:Employee (full-time)
Minimum Education Level:See Job Description
Visa Sponsorship: No
Related Industries:Nursing, Other

Cook Children's Health Care System is a not-for-profit, nationally recognized pediatric health care organization comprised of seven entities - a Medical Center, Physician Network, Home Health company, Northeast Hospital, Pediatric Surgery Center, Health Plan and Health Foundation. Based in Fort Worth, Texas, the integrated system has more than 60 primary and specialty care offices throughout North Texas. Its service region includes Denton, Hood, Johnson, Parker, Tarrant and Wise counties, with an additional referral area encompassing nearly half the state.

Cook Children's traces its roots back to 1918, but throughout its continual change and robust growth, it still embraces an inspiring promise - to improve the health of every child in its region through the prevention and treatment of illness, disease and injury. To live up to this promise, Cook Children's combines the art of caring with the use of leading technology and extraordinary collaboration to provide exceptional care for every child, every day. For more information, please visit

*Cook Children's Medical Center has requested along with applying online at you also fill out additional information on their site. Please click 'Apply Online' to begin the application process.

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