Clinical Appeals Specialist II-Hybrid

** Why Mayo Clinic*
* Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & World Report. As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation and comprehensive benefit plans ((Use the "Apply for this Job" box below).)  - to take care of you and your family, now and in the future.

And with continuing education and advancement opportunities at every turn, you can build a long, successful career with Mayo Clinic.

** Benefits Highlights*
* + Medical:
Multiple plan options.

+ Dental:
Delta Dental or reimbursement account for flexible coverage.

+ Vision:
Affordable plan with national network.

+ Pre-Tax Savings: HSA and FSAs for eligible expenses.

+ Retirement:
Competitive retirement package to secure your future.

** Responsibilities*
* ** 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.

** Qualifications*
* Minimum Education:

Associates Degree

Minimum Experience:

3 years of relevant nursing experience

** Current active unrestricted RN license.*
* ** The preferred applicant will have the following experience:
** Prior Authorization Experience, Advanced knowledge of ICD-10-CM/PCS coding conventions, DRG reimbursement methodology, and clinical validation principles, with demonstrated ability to interpret Coding Clinic guidance and Medicare IPPS regulations to support accurate DRG assignment and defend coding-related denials.

Healthcare Financial Management Association (HFMA) Certification Preferred.

CCDS or CDIP Certification Preferred.

Experience in utilization review, case management, denials and appeals, revenue cycle, or prior authorization preferred. Knowledge and use of discharge planning, case management, utilization review, and levels of care criteria. Familiarity with Medicaid and Medicare claims denials and appeals processing and regulatory requirements. Knowledge and use of payer medical policy and Medicare LCD/NCD criteria. Knowledge of billing and coding requirements. Experience utilizing Milliman Care Guidelines and Inter Qual Criteria.

Knowledge of current NCQA/URAC standards. Knowledge and experience applying 2-Midnight Rule Criteria. 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.

**** This vacancy is not eligible for sponsorship / we will not sponsor or transfer visas for this position.
** _During the selection process, you may participate in an OnDemand (pre-recorded) interview that you can complete at your convenience. During the OnDemand interview, a question will appear on your screen, and you will have time to consider each question before responding. You will have the opportunity to re-record your answer to each question - Mayo Clinic will only see the final recording.

The complete interview will be reviewed by a Mayo Clinic staff member and you will be notified of next steps._

** Exemption Status*
* Exempt

** Compensation Detail*
* $88,358 - $123,780/ year;

** Benefits Eligible*
* Yes

** Schedule*
* Full Time

** Hours/Pay Period*
* 80

** Schedule Details*
* M-F 8-5pm Local time

** International…