Solaris Health

Director

• Developing, implementing and coordinating managed care contracting
• Completing data reporting and analytical needs for the Managed Care department
• Supports leadership in all payer and health plan contract negotiations
• Monitors contract performance and tracks key statistics

Director, Managed Care Analytics

Financial Planning and Analysis

• Ensure patients are financially cleared prior to receiving services by verifying insurance eligibility and obtaining prior authorizations.
• Verify insurance coverage and benefit information using payer portals, clearinghouses, and direct communication with insurers.
• Confirm plan status, effective dates, co-pays, deductibles, coinsurance, and authorization requirements.
• Accurately document verification results in the EHR and/or PM.
• Submit prior authorization requests for services, tests, and procedures based on payer requirements.
• Monitor and follow up on pending authorizations to avoid delays in patient care.
• Address denied or delayed authorizations with payers and escalate unresolved issues to the Supervisor as needed.
• Coordinate with clinical staff to gather and submit necessary documentation for authorization approval.
• Notify appropriate teams of coverage issues, authorization status, or patient financial risk.
• Communicate with patients regarding their insurance coverage, financial responsibilities, and authorization outcomes when appropriate.
• Collaborate with schedulers and front-desk teams to ensure appointments align with insurance requirements.
• Follow standardized workflows and documentation protocols as outlined by the Supervisor.
• Maintain accuracy and timeliness in all financial clearance documentation.
• Participate in daily team huddles and contribute to process improvement initiatives.

Financial Clearance Specialist

Insurance

• Initiate and track insurance prior authorizations for scheduled procedures, imaging, and other medical services
• Verify insurance eligibility and benefits using payer portals or through direct contact with payers
• Accurately document authorization statuses in the electronic medical record (EMR) and Practice Management (PM) system
• Ensure all authorizations are obtained prior to the scheduled date of service to avoid delays or denials
• Work closely with the Manager/Supervisor and Team Lead of Financial Clearance to escalate urgent or complex authorization cases
• Support team objectives and contribute to departmental huddles and workflow optimization initiatives
• Participate in ongoing training and feedback sessions led by the Supervisor to enhance performance and process compliance
• Communicate with insurance carriers to gather necessary clinical documentation and follow up on pending requests
• Identify and report recurring payer issues or trends to the Supervisor for team-level resolution or escalation
• Inform patients of authorization status, potential delays, and what to expect if coverage issues arise
• Coordinate with patient estimation staff to ensure authorizations align with cost estimates and pre-service collections efforts
• Performs other position related duties as assigned.

Medical Billing – Insurance Authorization Specialist

• The Financial Clearance Specialist is responsible for ensuring patients are financially cleared prior to receiving services by verifying insurance eligibility and obtaining prior authorizations.
• Verify insurance coverage and benefit information using payer portals, clearinghouses, and direct communication with insurers.
• Confirm plan status, effective dates, co-pays, deductibles, coinsurance, and authorization requirements.
• Accurately document verification results in the EHR and/or PM.
• Submit prior authorization requests for services, tests, and procedures based on payer requirements.
• Monitor and follow up on pending authorizations to avoid delays in patient care.
• Address denied or delayed authorizations with payers and escalate unresolved issues to the Supervisor as needed.
• Coordinate with clinical staff to gather and submit necessary documentation for authorization approval.
• Notify appropriate teams of coverage issues, authorization status, or patient financial risk.
• Communicate with patients regarding their insurance coverage, financial responsibilities, and authorization outcomes when appropriate.
• Collaborate with schedulers and front-desk teams to ensure appointments align with insurance requirements.
• Follow standardized workflows and documentation protocols as outlined by the Supervisor.
• Maintain accuracy and timeliness in all financial clearance documentation.
• Participate in daily team huddles and contribute to process improvement initiatives.
• Performs other position related duties as assigned.

Medical Billing, Financial Clearance Specialist

• The Insurance Authorization Specialist is responsible for securing insurance authorizations for medical services to ensure timely patient care and accurate reimbursement.
• Work closely with the Manager/Supervisor and Team Lead of Financial Clearance to escalate urgent or complex authorization cases.
• Initiate and track insurance prior authorizations for scheduled procedures, imaging, and other medical services.
• Verify insurance eligibility and benefits using payer portals or through direct contact with payers.
• Ensure all authorizations are obtained prior to the scheduled date of service to avoid delays or denials.
• Communicate with insurance carriers to gather necessary clinical documentation and follow up on pending requests.
• Support team objectives and contribute to departmental huddles and workflow optimization initiatives.

Insurance Authorization Specialist

Accounts Receivable

• Perform billing-related tasks including data entry, claim review, charge review, and accounts receivable follow-up.
• Resolve high-complexity insurance accounts including denials related to medical necessity, non-covered services, bundling, and out-of-network claims (OON).
• Manage higher volume and complexity of work compared to Levels I and II while meeting productivity standards.
• Complete daily tasks in assigned work queues according to established workflows and manager direction.
• Utilize CBO Pathways, payer websites, billing systems, and training materials to resolve unpaid or incorrectly paid claims and authorize procedures.
• Identify and escalate payer issues, credentialing discrepancies, or coding concerns to management.
• Review reports to identify revenue opportunities and outstanding claims requiring follow-up.
• Adhere to departmental workflows, regulatory requirements, FGP compliance, and patient confidentiality guidelines (HIPAA).
• Communicate with patients, providers, coders, and other stakeholders to ensure accurate and timely claims processing.
• Provide insight and feedback on system edits, billing processes, and procedural improvements.
• Make corrections to system records to meet payer requirements and resubmit claims.
• Train and mentor new hires and provide guidance to team members as needed.
• Review and write appeals and assist staff in resolving complex claim or appeal-related questions.
• Perform other position-related duties and comply with Solaris Health Code of Conduct and annual compliance training.

Insurance Accounts Receivable Specialist III

• NO WEEKENDS, NO EVENINGS, NO HOLIDAYS We offer competitive pay as well as PTO, Holiday pay, and comprehensive benefits package! GENERAL SUMMARY The Financial Clearance Specialist is responsible for ensuring patients are financially cleared prior to receiving services by verifying insurance eligibility and obtaining prior authorizations. This dual-function role ensures accurate documentation, compliance with payer guidelines, and supports timely and efficient patient care. The Specialist works closely with scheduling, clinical, and billing teams under the guidance of the Manager/Supervisor of Financial Clearance.