RN Appeals Specialist for AI-Driven Medical Necessity

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

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.