... appeal submission or audit responses. Utilizes clinical expertise and critical thinking in the ... validation principles, with demonstrated ability to interpret Coding Clinic guidance and Medicare ...
... appeal submission or audit responses. Utilizes clinical expertise and critical thinking in the ... validation principles, with demonstrated ability to interpret Coding Clinic guidance and Medicare ...
Clinical Appeals Specialist II-Hybrid
Rochester, MN · On-site
$88K - $123K/yr
... appeal submission or audit responses. Utilizes clinical expertise and critical thinking in the ... validation principles, with demonstrated ability to interpret Coding Clinic guidance and Medicare ...
Clinical Appeals Specialist II-Hybrid
Rochester, MN · On-site
$88K - $123K/yr
... appeal submission or audit responses. Utilizes clinical expertise and critical thinking in the ... validation principles, with demonstrated ability to interpret Coding Clinic guidance and Medicare ...
... appeal submission or audit responses. Utilizes clinical expertise and critical thinking in the ... validation principles, with demonstrated ability to interpret Coding Clinic guidance and Medicare ...
... appeal submission or audit responses. Utilizes clinical expertise and critical thinking in the ... validation principles, with demonstrated ability to interpret Coding Clinic guidance and Medicare ...
Clinical Appeals Specialist II-Hybrid
Rochester, MN · On-site
$88K - $123K/yr
... appeal submission or audit responses. Utilizes clinical expertise and critical thinking in the ... validation principles, with demonstrated ability to interpret Coding Clinic guidance and Medicare ...
Clinical Appeals Specialist II-Hybrid
Rochester, MN · On-site
$88K - $123K/yr
... appeal submission or audit responses. Utilizes clinical expertise and critical thinking in the ... validation principles, with demonstrated ability to interpret Coding Clinic guidance and Medicare ...
MHN Manager of HIM
Huntington, WV · On-site
Oversee clinical validation and DRG validation denials, including appeal development, payer communication, denial trend analysis, and prevention strategies. * Lead HIM denials meetings and support ...
MHN Manager of HIM
Huntington, WV · On-site
Oversee clinical validation and DRG validation denials, including appeal development, payer communication, denial trend analysis, and prevention strategies. * Lead HIM denials meetings and support ...
Clinical Coding Appeals Nurse
$65K - $116K/yr
Review and interpret medical records to appeal denied and underpaid claims. * Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer ...
Clinical Coding Appeals Nurse
$65K - $116K/yr
Review and interpret medical records to appeal denied and underpaid claims. * Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer ...
... appeal submission or audit responses. Utilizes clinical expertise and critical thinking in the ... validation principles, with demonstrated ability to interpret Coding Clinic guidance and Medicare ...
... appeal submission or audit responses. Utilizes clinical expertise and critical thinking in the ... validation principles, with demonstrated ability to interpret Coding Clinic guidance and Medicare ...
... appeal submission or audit responses. Utilizes clinical expertise and critical thinking in the ... validation principles, with demonstrated ability to interpret Coding Clinic guidance and Medicare ...
... appeal submission or audit responses. Utilizes clinical expertise and critical thinking in the ... validation principles, with demonstrated ability to interpret Coding Clinic guidance and Medicare ...
Clinical Coding Appeals Nurse
Detroit, MI · On-site
$65K - $116K/yr
Review and interpret medical records to appeal denied and underpaid claims. * Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer ...
Clinical Coding Appeals Nurse
Detroit, MI · On-site
$65K - $116K/yr
Review and interpret medical records to appeal denied and underpaid claims. * Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer ...
Clinical Coding Appeals Nurse
Frankfort, KY · On-site
$65K - $116K/yr
Review and interpret medical records to appeal denied and underpaid claims. * Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer ...
Clinical Coding Appeals Nurse
Frankfort, KY · On-site
$65K - $116K/yr
Review and interpret medical records to appeal denied and underpaid claims. * Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer ...
Clinical Coding Appeals Nurse
Boise, ID · On-site
$65K - $116K/yr
Review and interpret medical records to appeal denied and underpaid claims. * Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer ...
Clinical Coding Appeals Nurse
Boise, ID · On-site
$65K - $116K/yr
Review and interpret medical records to appeal denied and underpaid claims. * Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer ...
Clinical Coding Appeals Nurse
Columbus, OH · On-site
$65K - $116K/yr
Review and interpret medical records to appeal denied and underpaid claims. * Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer ...
Clinical Coding Appeals Nurse
Columbus, OH · On-site
$65K - $116K/yr
Review and interpret medical records to appeal denied and underpaid claims. * Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer ...
Clinical Coding Appeals Nurse
Chicago, IL · On-site
$65K - $116K/yr
Review and interpret medical records to appeal denied and underpaid claims. * Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer ...
Clinical Coding Appeals Nurse
Chicago, IL · On-site
$65K - $116K/yr
Review and interpret medical records to appeal denied and underpaid claims. * Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer ...
Clinical Coding Appeals Nurse
Salt Lake City, UT · On-site
$65K - $116K/yr
Review and interpret medical records to appeal denied and underpaid claims. * Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer ...
Clinical Coding Appeals Nurse
Salt Lake City, UT · On-site
$65K - $116K/yr
Review and interpret medical records to appeal denied and underpaid claims. * Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer ...
Physician Reviewer
Manhattan, NY · On-site
Responsibilities: * Perform DRG Clinical Validation reviews to ensure diagnoses are accurate ... Conduct readmission and level of care reviews, including outlier and appeal cases * Collaborate ...
Physician Reviewer
Manhattan, NY · On-site
Responsibilities: * Perform DRG Clinical Validation reviews to ensure diagnoses are accurate ... Conduct readmission and level of care reviews, including outlier and appeal cases * Collaborate ...
Responsibilities: * Perform DRG Clinical Validation reviews to ensure diagnoses are accurate ... Conduct readmission and level of care reviews, including outlier and appeal cases * Collaborate ...
Responsibilities: * Perform DRG Clinical Validation reviews to ensure diagnoses are accurate ... Conduct readmission and level of care reviews, including outlier and appeal cases * Collaborate ...
Physician Reviewer
Manhattan, NY · On-site +1
Responsibilities: * Perform DRG Clinical Validation reviews to ensure diagnoses are accurate ... Conduct readmission and level of care reviews, including outlier and appeal cases * Collaborate ...
Physician Reviewer
Manhattan, NY · On-site +1
Responsibilities: * Perform DRG Clinical Validation reviews to ensure diagnoses are accurate ... Conduct readmission and level of care reviews, including outlier and appeal cases * Collaborate ...
Physician Reviewer
Manhattan, NY · Remote
Responsibilities: * Perform DRG Clinical Validation reviews to ensure diagnoses are accurate ... Conduct readmission and level of care reviews, including outlier and appeal cases * Collaborate ...
Quick apply
Physician Reviewer
Manhattan, NY · Remote
Responsibilities: * Perform DRG Clinical Validation reviews to ensure diagnoses are accurate ... Conduct readmission and level of care reviews, including outlier and appeal cases * Collaborate ...
Experience with a variety of appeal types, including but not limited to DRG downgrade, Clinical Validation, Large Claim Audit, Transplant, etc. * Overall hospital operations experience with multi ...
Experience with a variety of appeal types, including but not limited to DRG downgrade, Clinical Validation, Large Claim Audit, Transplant, etc. * Overall hospital operations experience with multi ...
Experience with a variety of appeal types, including but not limited to DRG downgrade, Clinical Validation, Large Claim Audit, Transplant, etc. * Overall hospital operations experience with multi ...
Experience with a variety of appeal types, including but not limited to DRG downgrade, Clinical Validation, Large Claim Audit, Transplant, etc. * Overall hospital operations experience with multi ...
Clinical Validation Appeal information
See salary details
$15.87 - $21.28
3% of jobs
$21.28 - $26.70
3% of jobs
$26.70 - $32.12
3% of jobs
$32.12 - $37.54
8% of jobs
$39.98 is the 25th percentile. Wages below this are outliers.
$37.54 - $42.96
16% of jobs
$42.96 - $48.38
9% of jobs
The median wage is $50.58 / hr.
$48.38 - $53.80
17% of jobs
$58.95 is the 75th percentile. Wages above this are outliers.
$53.80 - $59.22
16% of jobs
$59.22 - $64.64
8% of jobs
$64.64 - $70.06
7% of jobs
$70.06 - $75.48
8% of jobs
$15
$50
$75
How much do clinical validation appeal jobs pay per hour?
As of Sep 10, 2026, the average hourly pay for clinical validation appeal in the United States is $50.45, according to ZipRecruiter salary data. Most workers in this role earn between $39.66 and $61.30 per hour, depending on experience, location, and employer.
What are popular job titles related to Clinical Validation Appeal jobs?
For Clinical Validation Appeal jobs, the most frequently searched job titles are:
Clinical Appeals Specialist II-Hybrid
Rochester, MN • Hybrid
Mayo Clinic •
Hospitals • 10K+ employees10,000+ employees
Full-time
Medical, Dental, Vision, Retirement
Re-posted 11 days ago
Mayo Clinic rating
7.8
Based on 707 frontline employees who took The Breakroom Quiz
137th of 898 rated healthcare providers
Job description
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.
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.
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.
Just as our reputation has spread beyond our Minnesota roots, so have our locations. Today, our employees are located at our three major campuses in Phoenix/Scottsdale, Arizona, Jacksonville, Florida, Rochester, Minnesota, and at Mayo Clinic Health System campuses throughout Midwestern communities, and at our international locations. Each Mayo Clinic location is a special place where our employees thrive in both their work and personal lives. Learn more about what each unique Mayo Clinic campus has to offer, and where your best fit is.
Equal Opportunity
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, protected veteran status or disability status. Learn more about the "EOE is the Law". Mayo Clinic participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization.
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: 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 InterQual 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.
What Mayo Clinic employees say
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Get the full story on Breakroom
About Mayo Clinic
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Mayo Clinic is the largest integrated, not-for-profit medical group practice in the world. We're building the future, one where the best possible care is available to everyone — and more people can heal at home. Our relentless research turns into earlier diagnoses and new cures. That's how we inspire hope in those who need it most. At Mayo Clinic, experts work together to solve the most challenging unmet needs of patients. Our history of innovation dates back almost 150 years, when brothers Will and Charlie Mayo pioneered an integrated, team-based approach to medicine. Today, that trailblazing spirit drives innovations like Mayo Clinic Platform — which powers new technologies to change how care is delivered to all.
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Rochester, MN, US
Year founded
1919