Registered Nurse Denials/Appeals Management Specialist

Job Description

Are you ready to elevate your nursing career?

Join our team as an RN Denials/Appeals Management Specialist for our Utilization Review team at MedStar Franklin Square Medical Center in Baltimore, Maryland.

This position is responsible for coordinating and monitoring the denial management and appeals process. The ideal candidate combines clinical, business, and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. The position also collaborates with physicians, Utilization Review RN's, Case Managers, revenue cycle personnel and payers to appeal denials. Candidate must be local and have experience in hospital utilization review or appeals/denials management.

MedStar Health is a great place to work and grow your career. We provide a supportive and inclusive work environment, comprehensive health and wellness benefits, generous PTO, tuition assistance, retirement plans, and many other benefits focused on your wellbeing.

Qualifications:

Education

• Associate's degree in nursing required and
• Bachelor's degree in nursing preferred

Experience

• 3-4 years 2 to 3 years clinical experience
• 3-4 years 2 to 3 years UR experience in health care setting preferred
• 1-2 years 2 years background/experience in hospital audits preferred

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure RN license in the District of Columbia or the State of Maryland depending on work location Upon Hire
• Certification in Utilization review, case management and health care quality Upon Hire preferred
• If MFM, maternal fetal medicine (MFM) coding and billing yearly seminars Upon Hire preferred

Knowledge, Skills, and Abilities

• Excellent verbal and written communication skills
• Persuasive writing skills required
• Working knowledge of Office Suite software applications preferred

About MedStar Health

MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It’s how we treat people.