Clinical Appeals Specialist II-Prior Authorization-Remote

We are seeking a highly motivated and reliable individual to join our team as a Per Diem Clinical Appeals Specialist. This position offers flexible scheduling after an initial full-time training period (at least three months). Following the training period, the expected commitment is a minimum of 16 hours per week, with flexible scheduling based on departmental needs. This role is ideal for candidates looking for flexibility while still committing to a consistent workload. 

Primary duties may include, but are not limited to, collection of clinical information necessary to initiate commercial payer authorization. Obtain and maintain appropriate documentation concerning services in accordance with reimbursement agency guidelines/policies. Consult with interdepartmental departments and staff to assure all relevant information regarding patient status and diagnosis are accurately reported. Submit for prior authorization via multiple sources of technology applications to insurance companies and contracted vendors. May need to notify physician and patient of authorization denials. 

Requires minimum of an Associates Degree and a minimum of 3 years of relevant nursing experience. 

Current active unrestricted RN license.

Strong clinical experience in neurosurgery, orthopedic surgery, and/or cardiac surgery is a plus. Analytical or critical thinking skills.  Experience in utilization review, case management, payer policy review, revenue cycle, or prior authorization preferred. Knowledge and use of payer medical policy and Medicare LCD/NCD criteria. Knowledge of billing and coding requirements. Knowledge of prior authorization requirements. Experience utilizing Milliman Care Guidelines and InterQual 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. Current active unrestricted RN license. Healthcare Financial Management Association (HFMA) Certification Preferred.

This vacancy is not eligible for sponsorship/ we will not sponsor or transfer visas for this position.

This position will accept applications until March 4, 2025.  This deadline may be extended if the necessary candidate pool is not met by this date.

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 – 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. You’ll thrive in an environment that supports innovation, is committed to ending racism and supporting diversity, equity and inclusion, and provides the resources you need to succeed.
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.