Insurance Accounts Receivable Specialist III

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Solaris Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2020

⚕️ Healthcare Insurance

🏥 Healthcare

🧬 Biotechnology

Healthcare Insurance • Healthcare • Biotechnology

Solaris Health is a leading national healthcare platform committed to enhancing access to specialty healthcare and continually improving patient outcomes. With over 1 million unique patients annually and 730+ providers across the country, Solaris Health operates 236+ patient offices in 14 states, focusing on innovative delivery of high-quality, value-driven care.

📋 Description

• The Insurance Accounts Receivable Specialist III handles the most complex claim scenarios and plays a key role in mentoring staff and supporting escalated issues. • Responsibilities include resolving out-of-network claims, reviewing and writing appeals, assisting with training, and serving as a resource for team members. • Perform billing-related tasks assigned, including data entry, claim review, charge review, and accounts receivable follow-up. • Focus on resolving high-complexity insurance accounts, including denials related to medical necessity, non-covered services, bundling, out-of-network claims (OON), and other advanced claim scenarios. • Manage a greater volume and complexity of work than Levels I and II, while maintaining quality and meeting productivity standards. • Complete daily tasks in assigned work queues in accordance with established workflows and manager direction. • Utilize CBO Pathways, payer websites, billing systems, and training materials to resolve unpaid or incorrectly paid claims and to authorize procedures within expected timeframes. • Identify and escalate payer issues, credentialing discrepancies, or coding concerns to management as needed. • Follow standard workflows as provided in training and proactively seek further education or clarification when necessary. • Review reports to identify revenue opportunities and outstanding claims requiring follow-up. • Adhere to departmental workflows, regulatory requirements, and FGP compliance and patient confidentiality guidelines. • Communicate effectively 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 to support revenue cycle efficiency. • Maintain patient confidentiality and consistently apply policies and procedures to ensure compliance and operational consistency. • Collaborate with colleagues, support departmental goals, and clearly explain processes and procedures to others as needed. • Make corrections to system records to meet payer requirements and resubmit claims accordingly. • 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. • Performs other position related duties as assigned.

🎯 Requirements

• Advanced knowledge of billing systems, denial management, and payer-specific requirements. • Ability to coach, train, and mentor other team members. • Strong analytical and decision-making skills; able to handle complex accounts independently. • Ability to identify trends, propose solutions, and contribute to process improvements. • Experience writing appeals and handling escalated claim issues. • Skill in using computer programs and applications including Microsoft Office. • High school diploma or equivalent required. • Associates degree in related field preferred. • Previous experience in a customer service or healthcare setting required.

🏖️ Benefits

• Health insurance • Dental insurance • Vision insurance • Life Insurance • Pet Insurance • Health savings account • Paid sick time • Paid time off • Paid holidays • Profit sharing • Retirement plan