Clinical Appeals Specialist II-Hybrid

Mayo Career Site UK; Rochester (MN); Hybrid; USD 68,000 - 90,000; Full time

Job summary

Mayo Clinic is seeking a hybrid-eligible reviewer to work within 100 miles of Mayo Clinic campuses. The role involves reviewing clinically related denials, payer audits, and payer correspondence, and preparing appeals or audit responses.

You will apply clinical expertise and critical thinking to evaluate medical records against criteria and contracts, and collaborate with revenue cycle, case management and practice stakeholders to defend denials and prevent recurrence.

Responsibilities

• Review clinically related denials, payer audits and payer correspondence.
• Prepare relevant appeal submissions or audit responses.
• Apply clinical expertise and critical thinking to evaluate medical records against criteria and contract requirements.
• Liaise with revenue cycle, case management and practice stakeholders to defend denials and identify denial prevention opportunities.

Job description

This is a hybrid position and must be located within 100 miles of any of the Mayo Clinic campuses for on-site expectations based on business needs.

Primary duties may include, but are not limited to, responsibility for reviewing assigned clinically related denials, payer audits, and payer correspondence as well as preparation of relevant appeal submission or audit responses. Utilizes clinical expertise and critical thinking in the evaluation of medical records against appropriate criteria and contract requirements and utilizes appropriate communication style to appeal or defend medically denied claims. Is a liaison and resource to revenue cycle, case management and practice stakeholders in defending clinically denied claims and providing relevant feedback to key stakeholders on denial prevention opportunities.