Clinical Appeals Supervisor - Franklin, TN

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Job description

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partners with DirectEmployers to promote this job for Community Health Systems. Clicking "Apply Now" or "Read more" on Lensa redirects you to the job board/employer site. Any information collected there is subject to their terms and privacy notice.

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.

Job Summary
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.

Essential Functions

• 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.

Qualifications

• Associate Degree in Nursing, Healthcare Administration, or a related field preferred
• 3-5 years of experience in healthcare appeals, denials management, or a related field required
• 1-2 years of leadership or supervisory experience preferred

Knowledge, Skills And Abilities

• 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.

Community Health Systems is one of the nation's leading healthcare providers. With healthcare delivery systems in 36 distinct markets across 14 states, CHS operates 69 affiliated hospitals with more than 10,000 beds and approximately 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, imaging centers, cancer centers, and ambulatory surgery centers.

Equal Employment Opportunity

This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to to obtain the main telephone number of the facility and ask for Human Resources.

If you have questions about this posting, please contact