Appeals Nurse Coordinator

Job not on LinkedIn

🔥 1 minute ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 12%

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

• Perform clinical reviews in accordance with managed care, payer, and CMS requirements • Assist with determining appropriate level of care and medical necessity • Review clinical documentation related to ICD-10 coding and DRG assignment • Support denial management and preparation of appeal correspondence • Evaluate whether documentation supports the care provided and applicable coding or reimbursement requirements • Provide feedback to internal and external partners regarding level of care, length of stay, case outcomes, and clinical documentation • Identify opportunities for clarification or additional medical-record documentation • Apply relevant clinical and industry guidelines when reviewing cases • Review cases using applicable utilization management and clinical documentation resources • Use AI-enabled tools to support research, documentation review, workflow efficiency, and case analysis • Research payer policies, contracts, and regulatory requirements • Communicate with payers and clients regarding claim determinations and appeal rationale • Maintain current knowledge of regulatory changes, clinical practice, payer requirements, healthcare technology, and industry standards • Document findings and identify trends or information relevant to client needs • Perform other related duties as assigned • Work as an individual contributor without supervisory responsibilities • Travel to home offices in Tennessee for training

🎯 Requirements

• Active RN or LPN license • Clinical nursing experience • Experience reviewing and interpreting medical records • Familiarity with healthcare reimbursement, medical necessity, utilization management, denials and appeals, clinical documentation, or related functions • Familiarity with ICD-10, DRG concepts, and electronic medical records • Familiarity with AI-enabled tools or other healthcare technology used to support clinical, documentation, research, or administrative workflows • Proficiency with common business applications, including Microsoft Word and Excel • Experience in utilization review, case management, auditing, denials and appeals, CDI, or DRG clinical validation • Familiarity with InterQual, MCG, CMS medical necessity requirements, and the Two-Midnight Rule • Familiarity with CDI resources and guidance, including ACDIS and similar industry resources • Experience with electronic medical record systems such as Epic, Cerner, or Meditech • Experience using AI-enabled tools in clinical review, documentation, research, appeals, or related healthcare workflows • Case management, coding, utilization review, or CDI certification • Must already be authorized to work in the United States on a full-time, permanent basis without current or future sponsorship • Must successfully pass a background check

🏖️ 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