Soleo Health

Billing Specialist

• Preparation of accurate medical claims based on contracted agreements for services to various payers (e.g. Commercial Payers, Government Payers, Employer/ Institutional Payers).
• Reviewing and identifying claims pricing discrepancies based on updates/changes to fee schedules.
• Creates and submits secondary electronic pharmacy and medical claims in a timely manner.
• Billing of manufacturer copays, which includes entering the necessary information into portal or billing via paper at time of initial billing.
• Monitors billing requirements pursuant to contracts with third party payers or government programs.
• Answer insurance/billing questions from branch staff and help educate.
• Review information from electronic medical records in patient account (IE: auth, benefit verification, orders, accounts receivable, etc.) to ensure preparation and submission of clean claims.
• Perform routine revenue review of claims billed within the current month.
• Answering incoming calls and triage if necessary.
• Create claim batches and process them via electronic submission.
• Manually process any claims that are not eligible for electronic billing.
• Identify any claims that need attention, make corrections, and resubmit.
• Ensure coding to the highest level of specificity and for maximum reimbursement by third party payers.
• Daily review and follow up of unbilled delivery tickets in billing review and ready to bill queues.
• Accurately notate patient accounts to reflect all actions made including marginal, split claim notes, missing COGS, etc.
• Coordinates with the pharmacy team daily to ensure any PBM issues are addressed and resolved, accepted into revenue and billed timely.
• Effectively utilize time and resources to meet performance goals.
• Provides exceptional Customer service to internal and external customers.
• Ensures compliance with federal, state, and local governments, third party contracts, and company policies.
• Clearly communicate any billing related issues to all appropriate parties including: Intake, collections, RBL, and manager.
• Monitoring the unbilled-pending invoices queues and communicate to the branch on missing or needed documents or information.
• Maintain current knowledge of departmental and organizational policies.

Director

• Lead and elevate our IT department's data initiatives
• Drive the strategic use of data to achieve organization goals and enhance business performance within the healthcare sector
• Develop, recommend, and implement comprehensive data strategies that leverage advanced analytics and intelligent data management practices while ensuring compliance with healthcare regulations
• Formulate and execute a robust data strategy that aligns with the company's overall business objectives and healthcare industry standards
• Establish and enforce data governance policies to ensure data integrity, security, and compliance with healthcare regulations
• Implement robust data security measures to protect sensitive healthcare information
• Lead initiatives to expand the use of advanced analytics and BI tools
• Lead the design and implementation of scalable data architecture and infrastructure tailored to healthcare applications
• Build and manage a high-performing data team, fostering a culture of continuous learning and innovation
• Collaborate with other senior leaders to integrate data-driven approaches into all aspects of the healthcare business
• Manage relationships with external vendors and partners to ensure the best solutions and services are being utilized

Senior Director, Data Management, Strategy

Client Services Representative

• Maintain relationships with assigned payer organization personnel in a customer service capacity
• Support Soleo Health’s contracted clients as assigned
• Communicate effectively with payers via email, phone, letter, or portal
• Collaborate with the assigned Payor Director or Senior Director
• Serve as Manager between payers and Soleo departments
• Manage daily communications with designated health plans
• Handle direct referral processes and respond to case managers within required timeframes
• Follow up on payer initiatives and program requirements
• Use Soleo software to review account notes and pricing
• Send updated logs as required by payers
• Act as primary contact for assigned payer initiatives
• Support contract implementation and ensure compliance
• Prepare and submit client reports by due dates
• Complete ad hoc reports and projects as requested
• Assist with reimbursement projects and address client billing inquiries
• Adhere to Soleo Health policies, procedures, and standards of conduct
• Attend mandatory annual training courses
• Report known or suspected violations of policies or standards
• Perform other related duties as assigned

Client Support Manager

Manager

• Generates billing statements for patients with balances remaining after all third party payments are received
• Works in tandem with the branches to identify exceptions or special circumstances related to the patient’s outstanding balance
• Communicates with patients regarding overdue balances, payment arrangements, and other billing concerns or inquiries
• Establishes and documents payment arrangements for patients with outstanding balances and monitors adherence to agreed upon collection schedules
• Manages the Patient Accounts Receivable including balances for copay/deductibles, Soleo Financial Assistance, and self-pay patients
• Performs necessary adjustments to invoice balances after all collection efforts have been exhausted
• Prepares patient refunds, as necessary
• Identifies and transfers delinquent patient accounts to the Company’s collection agency
• Creates and develops procedures for the efficient management of the Patient Accounts Receivable
• Develops strategies and new techniques to reduce bad debt losses, including recommended changes to billing and collection practices
• Manage the Mfg Co Pay A/R for prompt collections
• Manage the Soleo Financial Assistance Program, review incoming applications for final approval or denial and maintain the SAP Master Log
• Work with the Procurement Department to identify lost/missing DME and track the products though the collections process
• Ensures compliance with federal, state, and local governments, third party contracts, company policy, and general accounting practices
• Completes all necessary managerial tasks for direct reports including hiring, training, addressing performance issues, developing team goals and objectives, performance reviews, conflict resolution, and strategic planning
• Other duties as requested

Billing Specialist

Senior Director, Data Management, Strategy

Client Support Manager

Patient Accounts Manager