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Appeals & Health Benefits Analyst
2 months ago
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. YOU belong here.
What awaits you:
- This is a hybrid role requiring you to work in the Hanover, MD office 1 day per week
- Work-life balance
- 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
As an Appeals and Health Benefits Analyst, you'll:
- Regularly communicate with both internal and external customers concerning member and provider appeal, complaint, or grievance cases via verbal and written communication responses.
- Use managed care/insurance benefits, billing guidelines, and contracting as well as policies and procedures to research, process, document, and resolve cases.
- Outreach and explain procedures to members and providers.
- Be responsible for end-to-end processing including investigation, determination, and resolution of complaints, grievances, and/or appeals for all JHHP products.
- Regularly communicate with regulatory agencies to submit and receive information to include drafting detailed summaries of dental and third-party preauthorization and payment denial rationale.
- Act as a subject matter expert and assist with training.
- Be responsible for assisting with the day-to-day functions, which includes letter review and case distribution.
What you'll bring:
- 4+ years' experience in a health care delivery system or insurance setting. This must include 2+ years of complaints resolution experience.
- Thorough knowledge of administrative procedures, insurance guidelines and regulations understanding of medical terminology in addition to CPT codes and ICD-10 codes, HCPCS codes & revenue codes.
- In depth knowledge of managed care/insurance benefits, billing guidelines, and contracting as well as policies and procedures.
- Associates degree in business management, health care administration or related discipline. Equivalent experience may be substituted for degree.
Who we are:
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.
Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
