Role Description The Medicaid Pending Billing Specialist at POLARIS PHARMACY SERVICES is responsible for managing the billing process for Medicaid pending claims, ensuring timely resolution and rebilling. This role requires a detail-oriented professional who can effectively liaise with various stakeholders to facilitate appeals and provide financial assistance, while maintaining accurate documentation throughout the process. - Manage the pending queue for Medicaid claims, ensuring all claims are processed efficiently and accurately. - Resolve claim issues by identifying discrepancies and implementing solutions to facilitate timely payments. - Rebill Medicaid claims as necessary, ensuring compliance with relevant regulations and guidelines. - Serve as a liaison between POLARIS PHARMACY SERVICES and Medicaid representatives, facilitating communication and resolution of billing issues. - Handle appeals processes, working to overturn denied claims and secure payment. - Provide financial assistance guidance to patients and families, helping them navigate the complexities of Medicaid billing. - Maintain thorough and accurate documentation of all billing activities, ensuring records are up-to-date and accessible for auditing and reporting purposes. Qualifications - Strong knowledge of Medicaid billing procedures and regulations. - Excellent organizational skills with the ability to manage multiple tasks and priorities effectively. - Proficiency in using billing software and Microsoft Office Suite, including Excel and Word. - Strong analytical skills with attention to detail in documentation and claim resolution. - Effective communication skills to liaise with various stakeholders, including patients, insurance companies, and internal departments. - Ability to work independently and collaboratively in a fast-paced environment. - Problem-solving skills with a proactive approach to resolving billing issues and claims efficiently. Requirements - High school diploma or equivalent; an associate or bachelor's degree in healthcare administration, finance, or a related field is preferred. - Minimum of 2 years of experience in medical billing, preferably with Medicaid. - Proven experience in managing pending queues and resolving claims. - Experience in working with financial assistance programs and understanding of appeals processes. Benefits - Medical, Dental, and Vision insurance. - 401 (k) (available for Part Time & Full Time EEs). - Company Paid Life insurance. - Short-term and Long-term disability insurance. - Tuition reimbursement. - Personal Time Off (PTO). - Competitive pay with annual performance reviews and merit-based raises. - Career growth potential. - Annual on-site voluntary Flu Vaccines. - Employee referral bonus program.

Role Description Responsible for reviewing patient medical records after a visit and translating the information into codes that insurers use to process claims from patients. Duties include confirming treatments with medical staff, identifying missing information and submitting information to insurers for reimbursement. Participates in peer review to ensure accuracy and timeliness standards are maintained. Resolve complex coding questions that arise from team. - Evaluates medical record documentation and coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support outpatient visits and to ensure that data complies with legal standards and guidelines. - Interprets medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately assign and sequence the correct ICD-9-CM and CPT codes. - Provides technical guidance to physicians and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to approved coding principles/guidelines. - Manages complex coding situations and supports peers through challenging questions. - Peer reviews records for management to ensure accuracy of information. - Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes. - Researches, analyzes, recommends, and facilitates plan of action to correct discrepancies and prevent future coding errors. - Identifies reportable elements, complications, and other procedures. Qualifications - High School Diploma or Equivalent required or Associate's Degree Medical Billing and Coding preferred - Medical Coding Experience 2-3 years required - In-depth knowledge of medical coding systems, including ICD-10, CPT, and HCPCS, and their application in hospital billing. - Strong understanding of coding guidelines, regulations, and industry best practices. - Excellent leadership and team management skills, with the ability to motivate and develop coding team members. - Strong communication and interpersonal skills to effectively collaborate with healthcare providers, coders, and other stakeholders. - Strong problem-solving skills to address coding-related challenges and implement effective solutions. - Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment. Requirements - No experience in lieu of a degree accepted. Benefits - Competitive base pay - Comprehensive benefits - Career advancement opportunities - Differentials, premiums, and bonuses as applicable - Recognition programs designed to celebrate contributions and support professional growth

Role Description The Acute Coding Appeals Specialist integrates medical coding principles and objectivity in the performance of coding appeals activities. This role involves: - Drawing on ICD10CM, ICD10PCS, HCPCS, NCCI, CMS, and CMG coding expertise to substantiate coding principles. - Reviewing and writing appeals for inpatient Diagnosis Related Group (DRG) denials. - Addressing clinical documentation utilized in the decision-making process to support the validity of the assigned codes. Job Responsibilities include: - Integrating medical coding principles in coding appeals/denials activities. - Participating in client system education to ensure coding is supported by clinical documentation. - Maintaining meticulous documentation, spreadsheets, and claim examples of root cause issues. - Performing searches of governmental, payor-specific, and regulatory body guidelines to identify coding and billing requirements. - Assisting in education and training for client coding companions related to coding appeals outcomes. - Meeting established productivity standards for coding appeals and coding certification requirements. - Attending in-house sessions for updated coding information and changes in regulations. - Providing excellent customer service in an organized and efficient manner. Qualifications - Previous inpatient facility coding experience, working appeals, denials, and edits. - 5 years previous experience in coding. - Advanced knowledge of medical coding and billing systems, documentation, and regulatory requirements. - Inquisitive and open to innovation, including AI, to explore better processes. - Willingness to travel to client, temporary, or corporate office locations as business needs require. Requirements - High School Diploma or GED. - Active Coding Certification (i.e., RHIA, RHIT, CCS, CIC, CPC, COC, etc.). Benefits - Bonus Incentives. - Paid Certifications. - Tuition Reimbursement. - Comprehensive Benefits. - Career Advancement.

Role Description The Contracts Specialist will be responsible for supporting the contracts lifecycle, including drafting, reviewing, negotiating, and administering various types of commercial contracts to ensure compliance with company policies, legal requirements, and business objectives. - Draft, review, and negotiate a wide range of commercial agreements, including but not limited to, non-disclosure agreements (NDAs), master service agreements (MSAs), statements of work (SOWs), purchase agreements, and licensing agreements. - Collaborate with internal stakeholders such as legal, sales, procurement, and finance teams to understand business requirements and ensure contracts accurately reflect negotiated terms. - Identify and mitigate contractual risks, providing guidance and recommendations to internal teams on contract terms and conditions. - Maintain accurate and up-to-date contract records within the company's contract management system. - Assist in the development and implementation of contract templates, policies, and procedures to streamline contracting processes. - Monitor contract performance and compliance, addressing any deviations or breaches. - Support contract renewals, amendments, and terminations as needed. - Provide training and guidance to internal teams on contract-related matters. - Participate in special projects and initiatives related to contracts and legal operations. Benefits - Medical, dental, and vision insurance plans. - Paid time off accruing at a rate of 3.07 hours during your first year of employment. - 4 weeks of paid parental leave. - In 2026, 11 company-paid holidays (9 fixed holidays and 2 optional floating holidays), subject to change yearly. - 401(k) retirement plan. - Employee stock purchase plan.