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 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
The essential functions include, but are not limited to the following:
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.
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.
Other:
Experience in utilization review, case management, auditing, denials and appeals, CDI, or DRG clinical validation.
Familiarity with InterQual,…