Solaris Health

• Handle complex claim scenarios • Resolve out-of-network claims • Review and write appeals • Assist with training and mentorship of staff • Serve as a resource for team members • Perform billing-related tasks including data entry, claim and charge review • Manage a greater volume and complexity of work • Identify and escalate payer issues • Follow standard workflows and proactively seek further education • Review reports to identify revenue opportunities

• The IT Specialist is responsible for providing direct service support to users for a wide variety of computing devices/peripherals as well as all IT related functions. • Works autonomously fulfilling end user requests and resolving issues according to service and procedural standards. • Typical responsibilities involve moves, adds, and changes for computer devices, access requests/set up, application support and responding to break/fix service requests. • Required to participate in IT related projects as directed. • Maintains computer networks between locations and/or care centers. • Contributes to determining hardware and software specifications. • Responsible for application testing and documentation of workflow. • Provides user support and customer service to physicians and staff to resolve software and hardware issues. • Responds to questions from callers and walk-ins; remotely assists physicians and staff with technology problems in offices. • Communicates security information to all levels of the organization. • Under supervision, administers information security software and controls. • Follows standard Help Desk operation procedures; accurately logs all Help Desk contacts using tracking software for job tickets.

• Oversee patient accounts, verify and ensure the accuracy of accounts receivable (AR). • Contact patients to collect outstanding payments. • Research and resolve patient billing inquiries. • Accurately document all actions taken to reconcile outstanding balances. • Communicate with patients and insurance companies to resolve billing issues. • Ensure compliance with federal and state regulations. • Explain Care Credit to patients and encourage them to apply to resolve their balance in a timely manner. • Help patients create reasonable payment plans that suit their needs and support the financial health of facility. • Provide accurate customer service to patients and insurance companies. • Prepare specialized invoices and information as needed. • Prepare accurate files to send to the collection agency. • Verify patient demographics and update registration as required. • Performs other position related duties as assigned.

• 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.

• Responsible for performing entry-level insurance billing and follow-up tasks to support timely and accurate reimbursement. • Includes submitting claims, reviewing basic denials, and conducting follow-up on outstanding balances under supervision. • 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. • Effectively make system corrections and resubmit claims as necessary to meet payer requirements.

• Address patient billing inquiries • Resolve concerns or discrepancies • Collect outstanding balances for healthcare services • Ensure compliance with federal and state regulations • Communicate with patients and insurance companies to resolve billing issues

• 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.

• Responsible for successfully coding all cases to the highest level of accuracy. • Ensure quality and productivity standards are met. • Escalate coding issues with the Coding Supervisor. • Review chart documentation for accuracy and completeness. • Communicate with Claims Resolution Specialists and Business Office staff. • Demonstrate knowledge of CPT, HCPCS, modifiers, diagnosis codes, and medical terminology. • Collaborate with providers to obtain complete documentation to support coding. • Monitor compliance with policies and procedures. • Identify process opportunity trends and recommend improvements. • Maintain current knowledge of coding guidelines and relevant regulations. • Participate in special projects, personal development training, and cross-training.

• 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.

• 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.