Supervisor, Clinical Appeals Litigation (REMOTE)

Community Health Systems Professional Services Corporation•Franklin, TN

6d•Remote

About The Position

The Supervisor, Clinical Appeals oversees the coordination of audit and medical necessity denial appeals for an assigned team. The role ensures timely and accurate appeal submissions, compliance with regulatory standards, and achievement of service and production goals. The Supervisor provides day-to-day leadership, supports standardized appeal processes, and identifies trends and mitigates denial risks in collaboration with the Senior Director. The position supervises the review, preparation, and submission of medical necessity denial appeals; coordinates with Recovery Audit Contractors and other auditors; monitors performance and deadlines; conducts evidence-based research; and reports trends, risks, and improvement opportunities. It also collaborates with physician advisors and senior leaders, supports accurate data collection and reporting, develops training, coaches and evaluates team members, and participates in Administrative Law Judge hearings and other legal processes as required. The Payment Compliance and Contract Management team oversees the contract lifecycle, analyzes reimbursement discrepancies, improves revenue cycle processes, and supports financial accuracy and operational efficiency by ensuring compliance with contract terms and regulatory requirements.

Requirements

High school diploma or GED 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.
Effective communication and collaboration skills for working with auditors, legal teams, and internal stakeholders.
Strong analytical and problem-solving skills, including the ability to identify trends and implement solutions.
Proficiency in Google Suite, Microsoft Office Suite, and other relevant software applications.

Nice To Haves

Associate degree in Nursing, Healthcare Administration, or a related field preferred.
1–2 years of leadership or supervisory experience preferred.
RN – Registered Nurse state licensure and/or compact state licensure preferred.

Responsibilities

Supervise the team reviewing, preparing, and submitting medical necessity denial appeals according to standardized processes and established timelines.
Ensure timely communication with Recovery Audit Contractors and other auditors, including managing documentation requests and appeal submissions at all levels.
Monitor team performance and ensure compliance with regulatory requirements and appeal deadlines.
Conduct evidence-based research into common denial reasons and guide the team on accurate documentation.
Identify denial trends, compliance risks, and process improvement opportunities, and report findings to the Senior Director of Appeals.
Collaborate with physician advisors and senior leadership to address denial trends and support policy updates.
Ensure accurate data collection and reporting through Compliance 360 or equivalent software, and recommend system changes to improve tracking and reporting.
Develop and deliver training on appeals processes, compliance standards, and documentation requirements.
Coach and mentor team members, provide customized feedback, and conduct performance evaluations.
Participate in Administrative Law Judge hearings and other legal processes as required.
Perform other duties as assigned.
Maintain regular and reliable attendance.
Comply with all policies and standards.