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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.

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About This Position:

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 we offer:

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

Click on the link below to explore our amazing benefits!

https://jhhs.mybenefitsjhhs.com/

What you will need:

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; 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. Demonstrated proficiency in developing and utilizing spreadsheets, graphics and word processing.
5. 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.
6. Current knowledge of third-party reimbursement and admitting procedures.

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.