Overview
As a Mayo Clinic Clinical Appeals Specialist I – Remote, you will become a vital member of a dynamic team at one of the world’s most exceptional health care institutions. Our Nursing Care Model combines Relationship-Based Care with an evidence-based approach. This allows for a stronger connection between patient and caregiver, and a more individualized, appropriate type of care. You will also discover a culture of teamwork, professionalism and mutual respect, and—most importantly—a life-changing career.
Job Description
CityRochester
StateMinnesota
TelecommuteRemote
DepartmentFinanceDescription:Why Mayo Clinic
Mayo Clinic is the nation’s best hospital (U.S. News & World Report, 2021-2022) and ranked #1 in more specialties than any other care provider. We have a vast array of opportunities ranging from Nursing, Clinical, to Finance, IT, Administrative, Research and Support Services to name a few. Across all locations, you’ll find career opportunities that support diversity, equity and inclusion. At Mayo Clinic, we invest in you with opportunities for growth and development and our benefits and compensation package are highly competitive. We invite you to be a part of our team where you’ll discover a culture of teamwork, professionalism, mutual respect, and most importantly, a life-changing career!
Mayo Clinic offers a variety of employee benefits. For additional information please visit Mayo Clinic Benefits. Eligibility may vary.
Position description
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, clinical practice stakeholders in defending clinically denied claims and providing relevant feedback to key stakeholders on denial prevention opportunities.
Qualifications
High School Diploma/GED and a minimum 3 years of relevant clinical experience required
Additional qualifications
Experience in denials and appeals, revenue cycle, audits or prior authorization preferred. Knowledge and use of payer medical policy and Medicare LCD/NCD criteria. Familiarity with Medicaid and Medicare claims denials and appeals processing and regulatory requirements. Knowledge of billing and coding requirements. Knowledge and experience in Epic. Must have the ability to effectively utilize Microsoft Office Suite and possess basic data entry skills. Must possess excellent verbal, written and interpersonal communication skills, and able to balance multiple demands and respond to time constraints. Must have high-level skills in organization as well as problem solving and analytical skills.
License or certification
Current active unrestricted LPN license or allied health licensure or certification (Radiology, Respiratory Therapy, Paramedicine, etc.)
Exemption status
Non-exempt
Compensation Detail
$27.95 – $37.74/ hour
Benefits eligible
Yes
Schedule
Full Time
Hours / Pay period
80
Schedule details
100 % Remote, can work from any site.
Must be able to work an 8 hour shift Monday through Friday between department business hours.
Weekend schedule
N/A
Remote
Yes
Site description
Mayo Clinic is located in the heart of downtown Rochester, Minnesota, a vibrant, friendly city that provides a highly livable environment for more than 34,000 Mayo staff and students. The city is consistently ranked among the best places to live in the United States because of its affordable cost of living, healthy lifestyle, excellent school systems and exceptionally high quality of life.
Recruiter
Veronica Bartz
EOE
As an Affirmative Action and Equal Opportunity Employer Mayo Clinic is committed to creating an inclusive environment that values the diversity of its employees and does not discriminate against any employee or candidate. Women, minorities, veterans, people from the LGBTQ communities and people with disabilities are strongly encouraged to apply to join our teams. Reasonable accommodations to access job openings or to apply for a job are available.