Appeals Analyst

Xsolis; United States; On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

Medical/Dental/Vision insurance

401K company match

Flexible Paid Time Off

Paid parental leave

HSA/FSA options

Educational reimbursement

EAP & Mental Health services

Job summary

Xsolis, headquartered in Franklin, TN, seeks an Appeals Analyst to work with clients and representatives to investigate denied claims and secure reimbursement. This role requires understanding clinical policies, contracts, and regulations and the ability to craft persuasive arguments for recovery.

Successful candidates will build strong relationships with payers, providers, and clients, document investigations clearly, and help guide claims recovery while ensuring legal and contractual

Qualifications

• Experience in appeal and claim processing.
• Strong communication skills, both verbal and written.
• Ability to multi-task in a fast-paced environment.
• Knowledge of clinical policies, contracts and regulations.

Responsibilities

• Investigate denied claims and document investigation work to support reimbursement.
• Draft detailed, persuasive correspondence to effect reimbursement.
• Build relationships with insurance carriers, patients, attorneys, and employers to facilitate payment.
• Analyze claims to determine validity of denial and recovery options.
• Ensure compliance with contracts, guidelines and regulations within the claims recovery process.

Skills

Claims processing

Analytical thinking

Verbal & written communication

Customer service

MS Office

Negotiation

Education

High school diploma

Associate's degree or higher preferred

Tools

MS Office Suite

Job description

Redefining Healthcare with AI

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 - 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, health system, and health plan clients and earned repeated industry recognition. With recognition on the Inc. 5000 and Deloitte Technology Fast 500 lists, Xsolis is 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 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

The essential functions include, but are not limited to the following:

• 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

Minimum Qualifications (Knowledge, Skills, And Abilities)

• 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

Supervisory Responsibilities

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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.

Full-time Employees’ Total Rewards Package Include

• 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

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 athttps://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.