Appeals Nurse Coordinator

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.   

• 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.

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 

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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.