{"id":3118045,"url":"https://alion.io/job/xsolis-appeals-nurse-coordinator","title":"Appeals Nurse Coordinator","company":{"id":2223871,"name":"Xsolis","domain":"xsolis.com","url":"https://alion.io/company/xsolis","size_band":"51-200","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Greenhouse","truth_index":null},"role":"Administrative","role_family":"Administrative","seniority":null,"employment_type":"full_time","work_mode":"remote","remote_scope":"stated_countries","remote_scope_basis":"posting_text","remote_working_hours":null,"hiring_geo_confidence":"explicit","locations":[],"countries":[],"hiring_countries":["US"],"hiring_countries_total":1,"salary":null,"salary_estimate":{"min_usd":40000,"max_usd":87000,"period":"year","method":"role_country_seniority_unknown","sample_n":11684},"experience_years_min":null,"visa_sponsorship":true,"relocation_package":false,"has_equity":false,"technologies":[],"status":"live","first_seen_at":"2026-10-22T21:01:53Z","employer_posted_date":"2026-10-22","last_verified_at":"2026-10-27T20:48:45Z","board_verified":true,"closed_at":null,"days_open":5,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":5},"description":"Redefining Healthcare with AI \nXsolis 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. \nWe 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. \nOur 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. \nPosition Summary Details\n\nThe 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.\nThe 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.\nEssential Duties & Responsibilities\nThe essential functions include, but are not limited to the following:\nPerform clinical reviews in accordance with managed care, payer, and CMS requirements.\nAssist with determining appropriate level of care and medical necessity.\nReview clinical documentation related to ICD-10 coding and DRG assignment.\nSupport denial management and preparation of appeal correspondence.\nEvaluate whether documentation supports the care provided and applicable coding or reimbursement requirements.\nProvide feedback to internal and external partners regarding level of care, length of stay, case outcomes, and clinical documentation.\nIdentify opportunities for clarification or additional medical-record documentation.\nApply relevant clinical and industry guidelines when reviewing cases.\nReview cases using applicable utilization management and clinical documentation resources.\nUse available technology, including AI-enabled tools, to support research, documentation review, workflow efficiency, and case analysis as appropriate.\nResearch payer policies, contracts, and regulatory requirements as needed.\nCommunicate with payers and clients regarding claim determinations and appeal rationale.\nMaintain current knowledge of regulatory changes, clinical practice, payer requirements, healthcare technology, and industry standards.\nDocument findings and identify trends or other information relevant to client needs.\nPerform other related duties as assigned.\nMinimum Qualifications (Knowledge, Skills, and Abilities) \nActive RN or LPN license.\nClinical nursing experience.\nExperience reviewing and interpreting medical records.\nStrong written and verbal communication skills.\nAbility to organize, prioritize, and manage multiple cases.\nFamiliarity with healthcare reimbursement, medical necessity, utilization management, denials and appeals, clinical documentation, or related functions.\nFamiliarity with ICD-10, DRG concepts, and electronic medical records.\nFamiliarity with AI-enabled tools or other healthcare technology used to support clinical, documentation, research, or administrative workflows.\nProficiency with common business applications, including Microsoft Word and Excel.\nOther:\nExperience in utilization review, case management, auditing, denials and appeals, CDI, or DRG clinical validation.\nFamiliarity with InterQual, MCG, CMS medical necessity requirements, and the Two-Midnight Rule.\nFamiliarity with CDI resources and guidance, including ACDIS and similar industry resources.\nExperience with electronic medical record systems such as Epic, Cerner, or Meditech.\nExperience using AI-enabled tools in clinical review, documentation, research, appeals, or related healthcare workflows.\nCase management, coding, utilization review, or CDI certification.\nSupervisory Responsibilities\nThis role does not include supervisory responsibilities and is an individual contributor role.\nWorking Environment and Travel Requirements\nWork is typically in a normal office administrative environment involving minimal exposure to physical risks.\nPosition 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.\nThis role requires travel to our home offices in TN for training. \nPhysical Demands & Work Environment \nThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position.\nReasonable accommodations may be made to enable individuals with disabilities to perform the functions.\nIn 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. \nFull-time Employees’ Total Rewards package include: \nMedical/Dental/Vision insurance \n401K company match \nFlexible Paid Time Off \nPaid parental leave \nHSA/FSA options \nEducational reimbursement program \nEmployer-paid EAP & Mental Health services \n------- \nXsolis 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. \nAll 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. \nWork 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. \nAll official communications from our recruitment team will only come from @xsolis.com. Verify open roles at https://www.xsolis.com/about/careers. 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