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Job Details

Sr. Appeals Nurse Specialist

Requisition #: 209663
Location: Johns Hopkins Hospital, Baltimore, MD 21201
Category: Nursing
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: Jan. 24, 2020

Johns Hopkins Health System employs more than 20,000 people annually. When joining the Johns Hopkins Health System, you became 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. Great careers continually advance here.

Position Summary:

Under general supervision of the Revenue Cycle Director of Legal Compliance and Appeals, the Sr. Appeals Nurse Specialist performs activities to ensure appropriate financial remuneration for inpatient 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.

Competencies:

Education:

  • Baccalaureate degree, or associate degree, or diploma in nursing from an accredited School of Nursing.

    Knowledge:

  • Advanced knowledge of medical and legal terminology.
  • Significant experience in claims processing, third party billing, patient accounts management required.
  • Third party payer claims processing and denials knowledge helpful.
  • Strong background in appealing administrative denials and medical necessity denials with third party payers at various levels.
  • Advanced knowledge of database systems, billing applications, and reporting mechanisms.

    Skills:

  • Analysis and trending of statistical data in order to target sources of denial.
  • Formulates action plans for denial resolution in conjunction with various departments.
  • Ability to fully review and analyze contracts.
  • Must be able to successfully facilitate communication cross-departmentally concerning appeals and overturn of denials and third party payer issues

    Required Licensure Certification, etc.

  • Requires current registered nurse licensure in the State of Maryland

    Work Experience:

  • Five or more years related experience in a health care, health insurance industry, or professional billing area along with equivalent amount of demonstrated proficiency in developing and utilizing spreadsheets, graphics and word processing.

Full Time (40 hours)

Day Shift 8:30am to 5:00pm

Work Location: Keswick North Building

Working Conditions: Works in normal office environment where there is little discomfort to due to the extremes of heat, dust, noise, temperature and the like

Exempt, Pay Grade: NL

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.

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