Under the leadership of Patient Financial Services (PFS) management, the 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.
Associates in Nursing Required. Bachelors of Science in Nursing (BSN) Preferred.
Texas Registered Nurse License Required.
Minimum two (2) years previous experience in managed care and denials management in a healthcare business office setting required, or minimum five (5) years previous experience in areas such as case management, utilization management, clinical pathway.
Extensive knowledge of healthcare third party reimbursement, variance and denial records.
Understanding of Managed Care contracts, denials and payor methodology.
Effective oral and written communication skills.
Prior experience with Epic Hospital Billing Resolute Preferred.
Internal Number: 38500
About Cook Children's Health Care System
Cook Children's Health Care System embraces an inspiring Promise – to improve the health of every child in our region through the prevention and treatment of illness, disease and injury. Based in Fort Worth, Texas, we’re proud of our long and rich tradition of serving our community.