Clinical Appeals Supervisor - Denials & Compliance

Community Health Systems, Inc.; Franklin (TN); À distance; USD 70 000 - 95 000; Plein temps

Avantages offerts par ce poste

Health coverage

401(k) matching

Student loan support

Tuition assistance

Competitive pay & full benefits

Résumé du poste

Community Health Systems, Inc. is seeking a Supervisor, Clinical Appeals to lead the denial-appeals process for the assigned team. You will oversee timely submissions, ensure regulatory compliance, and drive production goals in collaboration with the Senior Director.

The role includes developing standard appeal processes, coaching staff, conducting denial-reason research, and coordinating with physicians and auditors. Regular attendance and potential hearing participation are required.

Qualifications

• 3–5 years of healthcare appeals or denials management experience.
• 1–2 years of leadership or supervisory experience.
• Strong knowledge of healthcare appeals and regulatory compliance.
• Proficiency with data tracking tools and documentation standards.

Responsabilités

• Oversees team responsible for reviewing, preparing, and submitting medical necessity denial appeals.
• Ensures timely communication with RACs and auditors for documentation and submissions.
• Monitors team performance and compliance with deadlines and regulations.
• Conducts evidence-based research to support appeals and guides documentation.
• Identifies denial trends and reports findings to the Senior Director of Appeals.
• Collaborates with physician advisors and leadership on policy updates.
• Ensures accurate data collection and reporting using Compliance 360 or equivalent.
• Develops and delivers training on appeals processes and documentation.
• Coaches and mentors team members; conducts performance evaluations.
• Participates in Administrative Law Judge hearings as required.

Connaissances

Leadership

Communication

Data management

Regulatory compliance

Analytical thinking

Formation

Associate Degree in Nursing, Healthcare Administration, or a related field

H.S. Diploma or GED

RN - Registered Nurse - State Licensure or Compact State Licensure

Outils

Compliance 360

Google Suite

Microsoft Office Suite

Description du poste

Community Health Systems, Inc. is seeking a Supervisor, Clinical Appeals to lead the denial-appeals process for the assigned team. You will oversee timely submissions, ensure regulatory compliance, and drive production goals in collaboration with the Senior Director.

The role includes developing standard appeal processes, coaching staff, conducting denial-reason research, and coordinating with physicians and auditors. Regular attendance and potential hearing participation are required.