Appeals Analyst

Job not on LinkedIn

🔥 0 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🚫👨‍🎓 No degree required

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Xsolis

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2013

🏥 Healthcare

☁️ SaaS

🤖 Artificial Intelligence

💰 $75M Private Equity Round - Xsolis on 2021-06

Healthcare • SaaS • Artificial Intelligence

Xsolis is an AI-driven healthcare technology company that builds SaaS solutions to improve collaboration between providers and payers and make medical necessity and utilization decisions more objective and efficient. Its proprietary Dragonfly® platform applies real-time predictive analytics, natural language processing, and machine learning to assign continuous medical necessity scores and anticipate level-of-care for every patient, supporting utilization management, denial prevention, and revenue cycle workflows. Headquartered in Franklin, Tennessee, Xsolis emphasizes a human-centered approach and has been recognized on the Inc. 5000 and Deloitte Technology Fast 500 lists.

📋 Description

• Investigate denied claims with clients and client representatives • Document investigations and actions taken through resolution in a claims recovery system • Resolve claims by reviewing supporting documentation, calculating benefits due, initiating payment, composing appeal letters, guiding resolution of non-routine claims, and auditing claims for appropriate payment • Maneuver through multiple facility patient accounting systems • Prepare reports using analytical information • Analyze claims to determine denial validity and recovery options • Draft detailed and convincing correspondence to effect reimbursement • Develop relationships with insurance carriers, patients, attorneys, and employers to facilitate reimbursement • Conduct research to build strong reimbursement arguments • Research and review clinical policies, contracts, and other materials to aid claims recovery • Work individually and within a team to identify trends and formulate recovery resolutions • Ensure legal compliance with guidelines, contracts, regulations, and the company's business plan • Maintain quality service by following provider and payer service practices and protocols

🎯 Requirements

• High school diploma required; Associate's degree or higher preferred • 2-4 years of experience in appeal and claim processing • Verbal and written communication • Customer service • Analytical skills • MS Office Suite • Negotiation, problem recognition, and resolution skills • Ability to multi-task • Ability to maneuver through multiple facility patient accounting systems • Strong understanding of clinical policies, contracts, and regulations • Must successfully pass a background check • Must already be authorized to work in the United States on a full-time, permanent basis without current or future sponsorship

🏖️ Benefits

• Medical/Dental/Vision insurance • 401K company match • Flexible Paid Time Off • Paid parental leave • HSA/FSA options • Educational reimbursement program • Employer-paid EAP & Mental Health services