RN Clinical Appeals Analyst – Payer/Denials

Johns Hopkins Medicine; Maryland; In loco; USD 55.000 - 85.000; Tempo pieno

Descrizione del lavoro

Johns Hopkins Medicine is seeking a skilled RN to review and resolve clinical appeals across all lines of business. You will communicate determinations in line with regulatory standards and support non-clinical staff dealing with denials and coding appeals.

You will also maintain structured tracking across logs, databases, and reporting tools to ensure timely resolutions. The ideal candidate holds an RN license in Maryland with a BSN preferred and at least three years of acute care experience.

Competenze

• Graduate of an accredited school of nursing required.
• RN license in Maryland required.
• BSN preferred.
• Minimum of three (3) years of acute care nursing experience required.
• Prior experience in health insurance or payer environment preferred.
• Experience with quality improvement initiatives a plus.

Mansioni

• Review and resolve clinical appeals submitted by providers and members across all lines of business.
• Communicate appeal determinations in accordance with regulatory requirements.
• Serve as a clinical resource to support non-clinical staff with administrative denials and coding-related appeals.
• Maintain accurate tracking of appeals through logs, databases, and reporting tools.

Conoscenze

Nursing

Clinical documentation

Regulatory knowledge

Formazione

RN license in MD

BSN preferred

Descrizione del lavoro

Johns Hopkins Medicine is seeking a skilled RN to review and resolve clinical appeals across all lines of business. You will communicate determinations in line with regulatory standards and support non-clinical staff dealing with denials and coding appeals.

You will also maintain structured tracking across logs, databases, and reporting tools to ensure timely resolutions. The ideal candidate holds an RN license in Maryland with a BSN preferred and at least three years of acute care experience.