[Hiring] Appeals Analyst @Xsolis, Inc

Role Description

The Appeals Analyst will work with our clients and client representatives to investigate denied claims, document investigation, and work to effect reimbursement for denied services. The Appeals Analyst will need a strong understanding of clinical policies, contracts, and regulations to guide research into claim denials. Aside from the technical know-how, a successful Appeals Analyst will also have the soft skills necessary to build relationships with clients, payers, and providers and the ability to draft a convincing argument for reimbursement.

Essential Duties & Responsibilities

• Ability to resolve claims by reviewing supporting documentation; calculating benefits due; initiating payment or composing appeal letters; guiding resolution of non-routine claims; auditing claims to ensure appropriate payment.
• Ability to maneuver through multiple facility patient accounting systems.
• Prepares reports by securing analytical information through to a finished product.
• Analyze claims to determine validity of denial/recovery options.
• Draft detailed & convincing correspondence to effect reimbursement.
• Develop relationships with insurance carriers, patients, attorneys, and employers to facilitate reimbursement.
• Conduct research when necessary to build a strong reimbursement argument.
• Research/Review clinical policies, contracts, and other media to aide in claims recovery.
• Work individually and within a team to identify trends from client inventories and formulate recovery resolution.
• Clearly and concisely document all actions taken to resolution within a claims recovery system.
• Ensures legal compliance by following guidelines, contracts, regulations, and the company's business plan.
• Maintains quality service by following corporate provider and payer service practices and protocols.

Qualifications

• 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.

Working Environment and Travel Requirements

• Work is typically in a normal office administrative environment involving minimal exposure to physical risks.
• Position requires little to moderate physical activity. Mostly sedentary work exerting up to 10 pounds of force occasionally or a negligible amount of force to lift, carry, push, pull, or otherwise move objects.
• Work involves sitting most of the time, but may involve walking or standing for brief periods of time. No significant stooping is usually required.
• This role requires travel to our home offices in TN for training.

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.

Company Description

Xsolis is an AI-driven technology company reducing administrative waste in healthcare by enabling smarter collaboration between providers and payers. Since 2013, our vision has been to create a frictionless healthcare system. We are proudly headquartered in Franklin, TN - one of the nation's fastest-growing hubs for healthcare innovation.