Clinical Appeals Specialist II - Denials & Revenue Impact

Mayo Foundation for Medical Education and Research; Rochester (MN); Hybrid; USD 88,358 - 123,780; Full time

Benefits offered by this job

Medical plan options

Dental coverage

Vision plan with national network

HSA/FSAs

Job summary

Mayo Clinic in Rochester, MN, is seeking a Registered Nurse to review clinically related denials, assist with payer audits, and prepare appeal submissions. The role requires an active RN license and at least 3 years of nursing experience, with knowledge of ICD-10-CM/PCS coding and payer policies.

This is a hybrid position within 100 miles of Mayo Clinic campuses, including Rochester. Responsibilities include collaboration with revenue cycle, case management, and practice stakeholders to defend

Qualifications

• Associate degree in nursing is required.
• Active RN license is required.
• 3+ years of nursing experience preferred.
• Experience with utilization review, denials and appeals is preferred.

Responsibilities

• Review clinically related denials and payer audits.
• Prepare appeal submissions or audit responses.
• Act as liaison to revenue cycle, case management and practice stakeholders.

Skills

RN license

Clinical documentation

Communication skills

Analytical skills

Microsoft Office

Education

Associates Degree

Tools

Epic

Milliman Care Guidelines

InterQual Criteria

MS Office

Job description

Mayo Clinic in Rochester, MN, is seeking a Registered Nurse to review clinically related denials, assist with payer audits, and prepare appeal submissions. The role requires an active RN license and at least 3 years of nursing experience, with knowledge of ICD-10-CM/PCS coding and payer policies.

This is a hybrid position within 100 miles of Mayo Clinic campuses, including Rochester. Responsibilities include collaboration with revenue cycle, case management, and practice stakeholders to defend