Solaris Health

Manager

• The Clearinghouse Implementation and Rejections Manager is responsible for ensuring that the clearinghouse is effectively integrated with the practice management systems.
• Customizing its features to fit the organizations workflow.
• Testing the system to ensure smooth operation.
• Lead on the transition and conversion to Waystar as the chosen clearinghouse.
• Complete enrollment process ensuring all necessary enrollment forms are completed for each payer including Medicare and Medicaid.
• Lead, mentor, and manage a team of front line employees.
• Train the team who will be working within the new clearinghouse while continuing to monitor the previous clearinghouse rejections.
• Analyze reports on clearinghouse rejections, denial trends, and error rates.

Clearinghouse Implementation and Rejections Manager

Accounts Receivable

• Perform billing-related tasks as assigned, including data entry, claim review, charge review, and accounts receivable follow-up.
• Focus on resolving entry-level insurance denials, such as those related to medical records, eligibility, and coordination of benefits (COB).
• Complete daily tasks within assigned work queues based on manager direction and established workflows.
• Utilize CBO Pathways, payer websites, billing systems, and training materials to determine appropriate actions for resolving unpaid or underpaid claims and authorizing procedures.
• Identify potential issues related to payer requirements, provider credentialing, or coding, and escalate to management as appropriate.
• Review reports to identify unpaid claims and potential revenue opportunities.
• Communicate effectively with providers, patients, coders, and other stakeholders to ensure accurate and timely claims processing.
• Adhere to departmental workflows, operational policies, compliance guidelines, and regulatory requirements, including FGP and patient confidentiality standards.
• Provide input on system edits, process improvements, policies, and billing procedures to support revenue cycle optimization.
• Participate in meetings and workgroups, complete all required training sessions, and actively seek additional training when needed.
• Read and apply policies and procedures to make informed decisions, coordinate functions with team members, and explain processes clearly to others.
• Make system corrections and resubmit claims as necessary to meet payer requirements.
• Performs other position-related duties as assigned.

Insurance Accounts Receivable Specialist

• Perform billing-related tasks as assigned, including data entry, claim review, charge review, and accounts receivable follow-up.
• Focus on resolving entry-level insurance denials, such as those related to medical records, eligibility, and coordination of benefits (COB).
• Complete daily tasks within assigned work queues based on manager direction and established workflows.
• Utilize CBO Pathways, payer websites, billing systems, and training materials to determine appropriate actions for resolving unpaid or underpaid claims and authorizing procedures.
• Identify potential issues related to payer requirements, provider credentialing, or coding, and escalate to management as appropriate.
• Review reports to identify unpaid claims and potential revenue opportunities.
• Communicate effectively with providers, patients, coders, and other stakeholders to ensure accurate and timely claims processing.
• Adhere to departmental workflows, operational policies, compliance guidelines, and regulatory requirements, including FGP and patient confidentiality standards.
• Provide input on system edits, process improvements, policies, and billing procedures to support revenue cycle optimization.
• Participate in meetings and workgroups, complete all required training sessions, and actively seek additional training when needed.
• Read and apply policies and procedures to make informed decisions, coordinate functions with team members, and explain processes clearly to others.
• Make system corrections and resubmit claims as necessary to meet payer requirements.
• Performs other position related duties as assigned.

Insurance Accounts Receivable Specialist I

Insurance

• The Insurance Authorization Specialist is responsible for securing insurance authorizations for medical services to ensure timely patient care and accurate reimbursement.
• 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.

Insurance Authorization Specialist

• The Coding and Revenue Integrity Manager has oversight of the revenue generating and coding processes and outcomes for designated Affiliate(s).
• Responsible for maintaining a strategic and leadership role for improving revenue results through oversight of administrative and financial processes to ensure claims are submitted timely and accurately as well as developing a centralized coding and charge reconciliation team to reduce duplication and streamline charge capture and coding functions.
• Ensures coding accuracy by facilitating coder education on current and compliant coding guidelines.
• Supports the planning, development, and administration of the coding quality assurance function and the designing of a Provider Documentation Education program to provide focused education to clinical and coding resources.
• Implements quality measures based on Physician captured charges, coding, and patient care documentation to ensure compliance with pertinent regulations, guidelines, and industry benchmarks.
• Establishes routine charge capture and coding audits and creates feedback process to ensure continuous improvement.
• Tracks and trends Key Performance Indicators (KPIs) to measure outcomes and document improved performance.
• Oversees data analysis, trending, and reporting of opportunities for improvement in the charge capture and documentation functions.

Coding and Revenue Integrity Manager

Director

• Responsible for the strategic oversight and operational leadership of the credit balance resolution and underpayment detection functions.
• Manage a team of internal staff and external vendors dedicated to identifying, resolving, and preventing payer and patient credit balances.
• Dispute inappropriate refund requests from payers and monitor takebacks for validity.
• Ensure timely and accurate refund processing.
• Design and implement processes to detect underpayments and develop actionable reporting.
• Drive process improvements using data and technology.
• Build and maintain processes to proactively detect payer underpayments including setting thresholds and exception reporting.
• Develops and manages technology to supplement team activities and monitors results for efficiency.

Director, Credit Balance Resolution – Underpayment Detection

Medical Billing and Coding

• The Insurance Accounts Receivable Specialist I is responsible for performing entry-level insurance billing and follow-up tasks to support timely and accurate reimbursement.
• This includes submitting claims, reviewing basic denials, and conducting follow-up on outstanding balances under supervision.
• The role focuses on learning workflows, applying standard procedures, and escalating more complex issues as needed.
• Perform billing-related tasks as assigned, including data entry, claim review, charge review, and accounts receivable follow-up.
• Focus on resolving entry-level insurance denials, such as those related to medical records, eligibility, and coordination of benefits (COB).
• Complete daily tasks within assigned work queues based on manager direction and established workflows.
• Utilize CBO Pathways, payer websites, billing systems, and training materials to determine appropriate actions for resolving unpaid or underpaid claims and authorizing procedures.
• Identify potential issues related to payer requirements, provider credentialing, or coding, and escalate to management as appropriate.
• Review reports to identify unpaid claims and potential revenue opportunities.
• Communicate effectively with providers, patients, coders, and other stakeholders to ensure accurate and timely claims processing.
• Adhere to departmental workflows, operational policies, compliance guidelines, and regulatory requirements, including FGP and patient confidentiality standards.
• Provide input on system edits, process improvements, policies, and billing procedures to support revenue cycle optimization.
• Participate in meetings and workgroups, complete all required training sessions, and actively seek additional training when needed.
• Read and apply policies and procedures to make informed decisions, coordinate functions with team members, and explain processes clearly to others.
• Make system corrections and resubmit claims as necessary to meet payer requirements.
• Performs other position related duties as assigned.