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Empowering the Hands that Heal

Revenue Cycle Clinical Appeals Nurse

Dallas, Texas

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ScionHealth strives to provide quality-driven, patient-centered acute and post-acute hospital solutions. The health system is focused on driving innovation, serving its communities, and investing in people and technology to deliver compassionate patient care and excellent health outcomes. Based in Louisville, ScionHealth operates 79 hospital campuses in 25 states – 61 long-term acute care hospitals and 18 community hospital campuses and associated health systems.

Success Profile

What do you need to be successful at ScionHealth? Here are the top traits we’re looking for:

  • Communicator
  • Creative
  • Deadline-oriented
  • Goal-oriented
  • Problem-solver
  • Strategic

Our Culture

  • Driven by quality: We believe that if we focus on delivering quality care, exceeding expectations related to customer service and supporting our people, our business results will follow.
  • We equip our hospitals and our people with the resources, technology and expertise they need to deliver the best possible care to patients.
  • We’re always looking to find better ways to support caregivers by improving what we do, sharing best practices, and responding to the changing needs of our people and the patients they serve.
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“ScionHealth allows leaders to inspire the organization to take responsibility for creating a better future.”

Jarrell King Talent Acquisition
Jarrell King, Talent Acquisition

Revenue Cycle Clinical Appeals Nurse

Dallas, Texas
Facility Cornerstone Healthcare Group
Req ID 469736 Post Date 09/05/2023 Category Accounting and Finance
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The Revenue Cycle Clinical Appeals Nurse is the liaison and point of contact for clinical denials and appeals that are received after claim submission. Responsible for the management and communication of denials/appeals received from third party payers, managed care companies, and/or government entities/auditors related to medical necessity and/or level of care.

Includes, but is not limited to the following:

  • Use their clinical knowledge, experience, and advanced critical thinking to ensure accuracy and integrity of the full life cycle of medical necessity denial determinations is properly administered
  • Evaluate clinical appeal letter correspondence for content, clarity, accuracy, and consistency
  • Package & send appeal and grievance information to the payors, monitors for the outcome of appeal and takes action accordingly (notify the provider and member as per delegation agreement), track all appeal information
  • Actively manage, maintain and communicate denial/appeal activity to appropriate stakeholders, and report suspected or emerging trends related to payer denials
  • Participate in the review of audit findings as needed


Minimum Qualifications:

  • Ability to project a professional image
  • Apply professional standards of practice in the work environment to both internal and external customers
  • Knowledge of regulatory standards, compliance requirements, hospital policies and procedures, and third party requirements
  • Familiar with medical terminology
  • Strong understanding and working knowledge of Medicare and Commercial admission regulations
  • Familiar with third-party admission and continued stay criteria
  • Working knowledge of personal computer and software applications used in job functions (Word processing, graphics, databases, spreadsheets, etc.)

Education and/or Experience:

  • A minimum of two years of Utilization Review/Case Management experience in either a managed care or hospital setting is required
  • A minimum of two years’ experience in the denial and appeal process preferred

Certificates, Licenses, Registrations:

  • RN license, in good standing and maintained current throughout employment
  • CCM, preferred
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  • Career Development

    We support growth and development for all our employees through various means and in programs designed to foster inclusion.

  • Healthcare

    Your health is important to us. We offer a comprehensive benefits program and resources to support healthy lifestyles for you and your family.

  • Retirement Plan

    Employees can contribute to their retirement with plans that allow for pre-tax or after-tax contributions through payroll deductions.

  • Paid Time Off

    With paid holidays and unlimited PTO, you are encouraged to take the time you need to relax and recharge with family and friends.

  • Work-Life Balance

    Work-life balance is not just a perk, it is encouraged. We believe that our employees work their best when they’re allowed to be their best selves in and out of the office.

  • Miscellaneous Benefits

    Whether you’re looking for pet insurance, identity theft protection, or select discounts from hundreds of local and national merchants, we have a variety of benefits that help provide peace of mind.

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  • Accounting and Finance, Dallas, Texas, United StatesRemove
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