[Hiring] Appeals Nurse Coordinator @Xsolis, Inc

Role Description

The Appeals Nurse Coordinator II provides concurrent review and appeals support for XSOLIS clients. This role reviews clinical documentation, supports denial and appeal activities, and evaluates medical necessity, level of care, and documentation related to ICD-10 coding and DRG assignment.

The ideal candidate will have a clinical nursing background and familiarity with:

• Utilization management
• Denials and appeals
• Clinical documentation integrity
• DRG clinical validation
• Payer requirements
• Applicable state and federal regulations
• AI-enabled tools used to support clinical review and healthcare workflows

Qualifications

• Active RN or LPN license
• Clinical nursing experience
• Experience reviewing and interpreting medical records
• Strong written and verbal communication skills
• Ability to organize, prioritize, and manage multiple cases
• 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

Requirements

• 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

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.

Our flagship product, Dragonfly®, is the first and only AI-driven platform to continuously assign real-time predictive scores for medical necessity.

Xsolis is also one of the fastest-growing privately-held companies in the country and across North America.