Sr. Appeals Nurse Specialist

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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

Click or copy and paste this link to our video to learn about our amazing legacy! https://www.youtube.com/watch?v=of06sf9kiHk

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 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.

What awaits you:

You can enjoy an environment that is continually recognized as one of the best workplaces in the world. In addition to working with some of the best and brightest in the medical field, we offer our employees generous benefits:

• Work-life balance
• Medical, Dental, and Vision Insurance
• 403B Savings Plan w/employer contribution
• Paid Time off & Paid holidays.
• Employee and Dependent Tuition assistance benefits.
• Health and wellness programs and MORE!

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.

Salary Range: Minimum 46.57/hour - Maximum 72.18/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.

JHM prioritizes the health and well-being of every employee. Come be healthy at Hopkins!

Diversity and Inclusion are Johns Hopkins Medicine Core Values. 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.