Appeals Nurse Analyst

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This is a remote position. Our organization is registered for remote work in the following states: MD, VA, DC, FL, PA, and DE.

This is a remote position. Our organization is registered for remote work in the following states: MD, VA, DC, FL, PA, and DE.

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. Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP 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. JHHP is a leader in provider-sponsored health plans and is poised for future growth.

What you'll do:

The Appeals Nurse Analyst completes timely resolutions of clinical appeals that are received from providers and members (based on documentation presented by appealing agent with references to federal, state and local regulations as well as InterQual, JHHC policy and procedures). Acts as a Clinical resource for non-clinical staff in review of administrative denials or appeals involving coding disputes and non-clinical appeals.

What awaits you:

• Work-life balance - This is a remote role!
• 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!

What you'll bring:

• 3+ years of acute care nursing experience; Clinical Appeals experience preferred
• Graduate of an accredited school of nursing; BSN highly preferred
• Current licensure as a RN in the State of Maryland (or if appropriate, a Compact RN license)
• Knowledge of health insurance standard of practice as evidenced by working in a payer environment whether case management, utilization management, appeals, or claims processing.
• Appeals experience in a payer environment is highly preferred.
• Knowledge of InterQual is preferred.
• Knowledge of ICD-10, CPT-4 and revenue coding and managed care case management preferred.
• Knowledge of claims processing and/or billing guidelines highly preferred
• Ability to be self-motivated and able to work independently to assess situations and respond appropriately, make independent decisions and the ability to initiate and implement policy and procedure as written.

Salary Range: Minimum 38.49/hour - Maximum 59.66/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.