Revenue Cycle Nurse Manager- Clinical Appeals

You weremeant for Hopkins! Come see why the Johns Hopkins Hospital is a world-renowned leader in patient care serving the greater Baltimore community and patients from all across the globe. Our friendly and knowledgeable staff teams provide support throughout our many specialty departments and centers from primary visits to emergency care.

What Awaits You

Career growth and development

Diverse and collaborative working environment

Affordable and comprehensive benefits package including Tuition Reimbursement

Job Summary:

Responsible for oversight of the denial and appeal processes for emergency outpatient and inpatient encounters ensuring effective team performance and process integrity for Johns Hopkins Health System hospitals. Provides leadership and accountability for revenue cycle denial and appeal operations supporting efficient and compliant workflows.Provides support for payer and vendor management. Implements the organizations regulatory reimbursement management plan in accordance with the mission and strategic goals of the organization federal and state law and regulations payer requirements and accreditation standards. Provides other JHM entities support in project planning and implementation. Manages staff development and performance management to maintain high standards and achieve organizational objectives.

Hours:

Full time (40 hours)

Day Shift Weekdays

Location:

Remote- Requires current Registered Nurse Licensure in the State of Maryland.

Qualifications:

• Bachelors Degree or Associate Degree in Nursing from an accredited School of Nursing.
• Requires current Registered Nurse Licensure in the State of Maryland.
• 7 years of experience in revenue cycle management or healthcare financial operations (Required)
• Excellent knowledge base related to nursing and reimbursement practices financial and data analysis third party payer regulations utilization management standards case management methodologies age specific and other regulatory and accreditation requirements related to Care Coordination and cost containment.

Essential Functions:

• Manages appeals inventory to ensure timeliness of appeals
• Reviews monthly quality staff audits and productivity reports and initiates performance improvement initiatives as needed.
• Develops and analyzes monthly departmental reports communicating results to staff and leadership.
• Collaborates cross-functionally with departments including Billing Managed Care Financial Clearance Utilization Management Patient Accounting and Denials Prevention.
• Assist with vendor relations activities including inventory management invoicing account reconciliation and facilitation of appeals completion through problem resolution as needed
• Works closely with key internal stakeholders to resolve issues and ensure timely communication of payer changes and updates to the team
• Implements policies procedures and workflow enhancements to improve operational efficiency and accuracy.
• Monitors performance metrics and prepares reports to support departmental decision-making.

Our competitiveBenefit Packageis designed to support the well-being and financial security of our employees and includes:

• Full medical dental and vision plans
• Retirement plans
• Paid time off (PTO)
• Tuition reimbursement for you and your dependents
• Tell a friend and get paid! Ask about our Employee Referral Program Bonus!
• And more! Visithttps:// Range: Minimum 48.32/hour - Maximum 74.90/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.

  The Hospital reserves the right to modify employee schedules as needed.

  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 an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity and expression age national origin mental or physical disability genetic information veteran status or any other status protected by federal state or local law.

  Johns Hopkins Health System and its affiliates are drug-free workplace employers.