Sr Appeals Nurse Specialist

Make it happen at HOPKINS!

This position is eligible for remote work, if you live in one of the following states: Maryland, Virginia, Delaware, Pennsylvania, Florida, or Washington DC.

Full-Time

Shift: Day

The mission of Johns Hopkins Medicine is to improve the health of the community and the world by setting the standard of excellence in medical education, research and clinical care. Johns Hopkins Medicine, a nonprofit, combines over 125 years of commitment to community care with groundbreaking research, teaching and medical services to patients worldwide. Johns Hopkins Medicine operates six academic and community hospitals, four health care and surgery centers, more than six ambulatory surgery centers and has more than 2.8 million outpatient encounters per year

What you will do:

Under general supervision of the Director, Revenue Cycle Management and/or Revenue Cycle Manager, Appeals and Denials, the Sr. Appeals Nurse Specialist performs activities to ensure appropriate financial remuneration for outpatient services from third party payers. The position provides a vital link between Patient Accounting, Utilization Management, and Insurance Companies. The individual will be responsible for tracking denied inpatient claims, work with the Appeals Specialist, the Office of Managed Care, payers, outside law firms, and other sources to overturn denials on appeal and be an integral part of the effort to obtain payment for services.

Who should Apply:

1. Baccalaureate degree, or associate degree, or diploma in nursing from an accredited School of Nursing.
2. A minimum of four years of experience in nursing in an acute care setting; minimum one year of appeals experience highly preferred; five or more years related experience in health care, health insurance industry, healthcare billing, or nursing experience in acute care setting.
3. Requires current registered nurse licensure in the State of Maryland.
4. Requires substantial knowledge of standard Utilization Management criteria, broad based clinical knowledge, familiarity with critical pathways, current regulatory requirements, and legislation with respect to third party payers and payer practice patterns.
5. Current knowledge of third-party reimbursement and admitting procedures.

We’re proud to offer a robust benefits package that supports your health, growth, and well-being. Discover our full offerings and costs here: mybenefitsjhhs.com

What Awaits You:

• Competitive pay and benefits that support you at every stage of your life and career.
• Retirement plans with employer contributions to help you plan confidently for the future.
• Generous time off so you can unplug, recharge, and enjoy life outside of work.
• Access to world-class facilities and innovative technology that fuel your curiosity.
• Endless opportunities to advance your career as part of the Johns Hopkins team.

Salary Range: Minimum 47.96/hour - Maximum 74.34/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

The Hospital reserves the right to modify employee schedules as needed.

We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.