Appeals Nurse Coordinator

Xsolis, Inc; Polska; Hybrid; PLN 291,000 - 389,000; Full time

Benefits offered by this job

401K matching

Flexible Paid Time Off

Paid parental leave

HSA/FSA options

Educational reimbursement

EAP & Mental Health

Job summary

Xsolis, Inc. is seeking an Appeals Nurse Coordinator II to provide concurrent review and appeals support for XSOLIS clients. You will evaluate medical necessity, level of care, and documentation related to ICD-10 coding and DRG assignment.

The ideal candidate has an active RN or LPN license, experience with utilization management, denials and appeals, CDI, and familiarity with AI-enabled tools used in clinical review and healthcare workflows.

Qualifications

• Active RN or LPN license.
• Experience reviewing and interpreting medical records.
• Familiarity with AI-enabled tools used to support clinical review and workflows.
• Proficiency with Microsoft Word and Excel.

Responsibilities

• 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 utilization management and clinical documentation resources.
• Use AI-enabled tools to support research, documentation review, workflow efficiency, and case analysis.

Skills

RN license

Clinical review

Utilization management

ICD-10

DRG concepts

AI-enabled tools

Communication

Microsoft Word

Microsoft Excel

Tools

Epic

Cerner

Meditech

Job description

Xsolisis 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 - we are at the heart of a thriving ecosystem of health systems, payers, and technology leaders.

Our flagship product, Dragonfly®, is the first and only AI-driven platform to continuously assign real-time predictive scores for medical necessity. Dragonfly has delivered proven results across 600+ hospital, healthsystem, and health plan clients and earned repeated industry recognition. With recognition on the Inc.5000 and Deloitte Technology Fast 500 lists, Xsolisis also one of the fastest-growing privately-held companies in the country and across North America, and we're looking for talented people to grow with us.

Position Summary Details

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, and AI-enabled tools used to support clinical review and healthcare workflows.

Essential Duties & Responsibilities

• 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 available technology, including AI-enabled tools, to support research, documentation review, workflow efficiency, and case analysis as appropriate.
• Research payer policies, contracts, and regulatory requirements as needed.
• 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 other information relevant to client needs.
• Perform other related duties as assigned.

Minimum Qualifications (Knowledge, Skills, and Abilities)

• Active RN or LPN license.
• 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.

Other

• 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.

Supervisory Responsibilities

This role does not include supervisory responsibilities and is an individual contributor role.

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.

Physical Demands & Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position.

Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.

In any role at Xsolis, it's a chance to make a complex healthcare system a little more efficient alongside a team that's passionate, fast-moving, and genuinely invested in your success. Your contributions will shape both our product and our culture.

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

Xsolis is proud to be an equal opportunity employer. We celebrate diversity and are committed to building an inclusive environment for all. We encourage candidates of every background to apply.

All candidates must successfully pass a background check and fall under the same security role, which includes access to sensitive information, including proprietary data and PHI.

Work Authorization Notice: Please note that we do not provide visa sponsorship or immigration support for this position. Applicants must already be authorized to work in the United States on a full-time, permanent basis without the need for current or future sponsorship.

All official communications from our recruitment team will only come from @xsolis.com. Verify open roles at https://www.xsolis.com/about/careers. For information regarding how we collect, use, and protect applicant personal information, please review our CCPA Privacy Notice for Job Applicants.