Clinical Appeals Supervisor

Community Health Systems Professional Services Corporation • Franklin, TN

3d

About The Position

The Supervisor, Clinical Appeals oversees the coordination of audit and medical necessity denial appeals for their assigned team. This role ensures timely and accurate appeal submissions, compliance with regulatory standards, and the achievement of service and production goals. The Supervisor provides day-to-day leadership, supports the development of standardized appeal processes, and works to identify trends and mitigate denial risks in collaboration with the Senior Director.

Requirements

• Associate Degree in Nursing, Healthcare Administration, or a related field required
• 3-5 years of experience in healthcare appeals, denials management, or a related field required
• Strong knowledge of healthcare appeals, denial management, and regulatory compliance.
• Proficiency in data management and tracking tools, including Compliance 360 or equivalent.
• Excellent leadership, coaching, and mentoring skills to support team development.
• Effective communication and collaboration skills to work with auditors, legal teams, and internal stakeholders.
• Strong analytical and problem-solving skills with the ability to identify trends and implement solutions.
• Proficiency in Google Suite, Microsoft Office Suite, and other relevant software applications.

Nice To Haves

• Bachelor's Degree in Nursing, Healthcare Administration, or a related field preferred
• 1-2 years of leadership or supervisory experience preferred

Responsibilities

• Supervises the team responsible for reviewing, preparing, and submitting medical necessity denial appeals in accordance with standardized processes and established timelines.
• Ensures timely communication with Recovery Audit Contractors (RACs) and other auditors, including managing requests for documentation and appeal submissions for all levels.
• Monitors team performance, ensuring compliance with regulatory requirements and appeal deadlines to maintain quality and efficiency.
• Conducts evidence-based research to support appeals for common denial reasons and provides team guidance to ensure accurate documentation.
• Identifies denial trends, compliance risks, and process improvement opportunities, reporting findings to the Senior Director of Appeals.
• Collaborates with physician advisors and senior leadership to address denial trends and support policy updates.
• Ensures accurate data collection and reporting through Compliance 360 or equivalent software, recommending system changes to improve tracking and reporting capabilities.
• Develops and delivers training to team members on appeals processes, compliance standards, and documentation requirements.
• Coaches and mentors team members to improve individual and team performance, providing customized feedback and conducting performance evaluations.
• Participates in Administrative Law Judge hearings and other legal processes as required.
• Performs other duties as assigned.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

Benefits

• Comprehensive Health Coverage – Medical, dental, and vision plans to keep you and your family healthy.
• Future Security: 401(k) with matching
• Student Loan Support – Up to $10,000 repayment assistance, because we invest in your future.
• Educational Tuition Assistance
• Competitive Pay & Full Benefits – A salary and package designed to reward your expertise and dedication.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree