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Posted: Monday, January 8, 2018 7:47 PM

Johns Hopkins Health System employs more than 20,000 people annually. Upon joining Johns Hopkins Health System, you become 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. If you share in our vision, mission and values and also have exceptional customer service and technical skills, we invite you to join those who are leaders and innovators in the healthcare field.

The Appeal Nurse Analyst position is responsible for timely resolution of clinical appeals as received from providers and members for all lines-of-business managed by JHHC. This individual will be responsible for:

* Review provider and member appeals based on situations and make appropriate determination based on documentation presented by appealing agent with references to federal, state and local regulations as well as JHHC policy and procedures based on line of business in a timely manner

* Communicating resolutions to appealent as required

* Providing resources to non-clinical staff in review of administrative denials or appeals involving coding disputes

* Tracking appeals on logs, databases and other data as appropriate

Requirements:

* A degree from an accredited school of nursing with current Maryland registration as a Nurse

* Bachelor's Degree of Nursing preferred

* Demonstrated knowledge in the health field as acquired during three (3) years of acute care nursing experience

* Knowledge of Interqual Milimen & Roberts or other utilization review tools; knowledge of ICD-9, CPT-4 and revenue coding and managed care case management is beneficial

* Experience with Tricare Operational regulations, COMAR, ERISA and claims processing and/or billing guidelines

* Excellent interpersonal skills and attitude to effectively project a positive image of managed care programs by being courteous, helpful, friendly, and professional in relationships with enrollees, families and co-workers

#LI-AH1

Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity,sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.

SDL2017


Associated topics: asn, bsn, care, ccu, domiciliary, intensive, intensive care, intensive care unit, psychiatric, registed

Source: http://www.jobs2careers.com/click.php?id=4737734259.96


• Location: Baltimore

• Post ID: 29864642 baltimore
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