About the role
Xsolis, an AI-driven healthcare technology company in Franklin, TN, is hiring a remote Appeals Nurse Coordinator who can hold either an RN or LPN/LVN license. You will review clinical records for medical necessity and level of care, support denial management and write appeal correspondence; training involves travel to the Tennessee home office.
Responsibilities
- Perform clinical reviews under managed care, payer and CMS requirements
- Assess level of care and medical necessity
- Review documentation tied to ICD-10 coding and DRG assignment
- Support denial management and appeal correspondence
- Give internal and external partners feedback on level of care, length of stay and documentation
- Research payer policies and regulatory requirements
- Use AI-enabled tools to support case review and workflow
Requirements
- Active RN or LPN license
- Clinical nursing experience and the ability to interpret medical records
- Familiarity with reimbursement, utilization management, denials and appeals, ICD-10, DRG concepts and EMR systems
- Proficiency in Microsoft Word and Excel
- Ability to manage multiple cases and communicate clearly in writing and speech
- Travel to Tennessee home offices for training
- Must already be authorized to work in the U.S.; no visa sponsorship; background check required
What we offer
- Medical, dental and vision insurance
- 401(k) with company match
- Flexible PTO
- Paid parental leave
- HSA/FSA options
- Educational reimbursement
- Employer-paid EAP and mental health services