Clinical Appeals Specialist II-Hybrid

Mayo Clinic•Rochester, MN

14d•$88,358 - $123,780•Hybrid

About The Position

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.

Requirements

Clinical expertise
Critical thinking skills
Appropriate communication style

Responsibilities

Reviewing assigned clinically related denials, payer audits, and payer correspondence.
Preparation of relevant appeal submission or audit responses.
Utilizing clinical expertise and critical thinking in the evaluation of medical records against appropriate criteria and contract requirements.
Utilizing appropriate communication style to appeal or defend medically denied claims.
Serving as a liaison and resource to revenue cycle, case management and practice stakeholders in defending clinically denied claims.
Providing relevant feedback to key stakeholders on denial prevention opportunities.