Maryland Licensed Appeals Nurse Specialist

Job Summary

Working remotely in a full-time capacity, the Maryland Licensed Appeals Nurse Specialist will manage denied inpatient claims, collaborate with various stakeholders to overturn denials, and ensure appropriate financial remuneration for outpatient services.

Key responsibilities

• Track and manage denied inpatient claims, working closely with Appeals Specialists and insurance companies
• Serve as a liaison between Patient Accounting, Utilization Management, and third-party payers
• Conduct appeals processes to secure payment for services rendered

Required qualifications

• Baccalaureate degree, associate degree, or diploma in nursing from an accredited School of Nursing
• A minimum of four years of nursing experience in an acute care setting, with at least one year of appeals experience preferred
• Current registered nurse licensure in the State of Maryland
• Substantial knowledge of Utilization Management criteria and third-party reimbursement processes
• Current knowledge of healthcare billing and regulatory requirements related to third-party payers