Appeals Manager (Nurse)
Requisition #: 188460
Location: Howard County General Hospital, Columbia, MD 21044
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: July 2, 2019
Johns Hopkins Health System employs more than 20,000 people annually. Upon joining Johns Hopkins Health System, you become part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. If you share in our vision, mission and values and also have exceptional customer service and technical skills, we invite you to join those who are leaders and innovators in the healthcare field.
The Manager, Appeals Department is under general direction of the Director of Revenue Cycle, the Manager of the Appeals Department is responsible for coordinating all the activities to file appeals on all HCGH claims denied in part or in full by any managed care insurers, all regular commercial carriers, and Medicaid insurers. Daily activities include the timely communication of adverse decisions, management of the entire appeals process and tracking these results within specified time frames. This includes the responsibility for review of all denied HCGH inpatient claims that are referred for the appeals process by Patient Accounting Coordinators. The Appeals Manager will write the actual appeal letters incorporating the clinical and related information, which she/he obtains from internal and external sources until completion. Communication is required internally (outside of the work group) to obtain, understand and exchange information. Job duties affect patient care through the completion of tasks that enable others to provide direct patient care and to collect on behalf of the patient their insurance benefits. The position requires face to face interaction with a variety of employees, physicians and external personnel. Innovativeness is required to improve work procedures and methods to collect monies due HCGH thereby reducing contractual allowances and bad debts. Interactions with external contacts include resolving complaints appropriate to the appeals process. The Appeals Manager must comprehend, interpret and communicate to others the complex claims, regulations and methodology regarding healthcare billing and reimbursement.
40 hours per week
10 or more years of related experience required
Bachelors Degree required
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.
Johns Hopkins Medicine.