Appeals and Health Benefit Analyst I

Johns Hopkins Health Plans is a leader in provider-sponsored health plans. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home. YOU belong here.

What awaits you:

• Work-life balance - This is a remote role. Applicants living in MD, DC, VA, PA, DE and FL will be given first consideration.
• 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 you are:

As the Appeals & Health Benefits Analyst for Johns Hopkins HealthCare, you are the conduit for a concerned member, vendor, or provider, and you realize the impact your knowledge of health plans has an impact on both our internal and external customer’s experience. You are a resource for claims, customer service, care management and the sites we serve.

What you’ll do:

• Communicate with both internal and external customers concerning benefit interpretation, appeals, disputes and claims issues
• Research incoming appeals/disputes and prepare written response. Use knowledge of Medicare Advantage (MA) claims, disputes, appeals, insurance regulations and managed care to explain procedures to vendors, providers and customers
• Act as a resource for claims, customer service, care management and sites.
• Responsible for review and payment determination of claims pended for determination/resolution or clarification of authorizations for MA claims.
• Work on the inquiries related to grievances and disputes

What you’ll bring:

• 3 years’ experience in an insurance setting
  • Medicare experience preferred.
• Knowledge of Medicare guidelines and regulations
• Knowledge of provider and member appeals and disputes rights and responsibilities
• Must be able to read and interpret providers’ contracts and members Explanation of Benefits
• Current knowledge of regulations and guidelines for insurance complaints.
• Knowledge of medical claims process and revenue cycle
• Understanding of medical terminology, CPT codes, ICD-10 codes and revenue codes
• Excellent customer service and problem solving skills

Who we are:

Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine. JHHC is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC is a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare, at Johns Hopkins HealthCare, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHC is the place to call home.

Salary Range: Minimum 20.22 per hour - Maximum 33.38 per 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.