Hybrid Clinical Appeals Specialist II

Mayo Clinic; Rochester (MN); Hybrid; USD 88,358 - 123,780; Full time

Job summary

Mayo Clinic seeks an experienced Registered Nurse to review clinically related denials, support payer audits, and prepare appeals. You will apply ICD-10-CM/PCS coding knowledge, DRG methodologies, and clinical validation to defend denials and ensure accurate DRG assignment.

The role requires strong MS Office skills, data entry accuracy, and excellent communication. This is a hybrid position located within 100 miles of Mayo Clinic campuses, based in Rochester, MN.

Qualifications

• Requires minimum Associates Degree and 3+ years nursing experience.
• Extensive knowledge of ICD-10-CM/PCS and DRG reimbursement.
• Experience with payer reviews, denials, and appeals processes.
• Proficiency in Microsoft Office and data entry; strong communication and analytical skills.

Responsibilities

• Review assigned clinically-related denials and payer audits.
• Prepare appeal submissions and audit responses.
• Defend coding-related denials using clinical criteria and contract requirements.
• Collaborate with revenue cycle, case management and practice stakeholders.

Skills

ICD-10-CM/PCS coding

DRG reimbursement

Clinical validation

Coding guidelines

Medicare IPPS

Communication skills

MS Office

Data entry

Analytical skills

Education

Associates Degree

Tools

Epic

Milliman Care Guidelines

InterQual Criteria

Job description

Mayo Clinic seeks an experienced Registered Nurse to review clinically related denials, support payer audits, and prepare appeals. You will apply ICD-10-CM/PCS coding knowledge, DRG methodologies, and clinical validation to defend denials and ensure accurate DRG assignment.

The role requires strong MS Office skills, data entry accuracy, and excellent communication. This is a hybrid position located within 100 miles of Mayo Clinic campuses, based in Rochester, MN.