About This Role
Billing and collections for a fertility practice are the core of this remote specialist role. The Billing Specialist manages insurance claims, resolves accounts receivable issues, and supports patient collections, working closely with insurance carriers, patients, and internal teams to ensure timely and accurate collections. This position suits a detail-oriented and knowledgeable professional who can help meet organizational billing and collection goals.
Responsibilities
- Review outstanding claims to determine necessary action and make status calls to insurance companies
- Research and resolve accounts receivable problems and disputed or delinquent account balances with patients and insurance companies, including misapplied payments, direct deposits, and overpayments
- Request claim reprocessing where necessary, or prepare and submit corrected claims to insurance companies for payment
- Research and resolve claim rejections and denials from electronic submissions, including accessing payer websites to identify the reason for rejection when needed
- Report on and work outstanding insurance and patient accounts receivable over 45 days, documenting collection efforts
- Review prior collection efforts each month to confirm payment was received
- Initiate appropriate collection action on delinquent accounts, including phone calls and correspondence to insurance carriers and patients
- Contact patients regarding balances after insurance processing, using a professional and compassionate tone, and send statements, reminders, and final notices on schedule
- Set up and monitor patient payment plans and auto-pay enrollments in line with clinic policy
- Post patient payments (credit card, ACH, check, cash) accurately and in a timely manner
- Answer patient calls and inquiries relating to their bills, explaining how claims were processed by the carrier and supplying documentation (e.g., EOBs, patient ledgers) as requested
- Update demographic and payer-related information obtained from patients
- Research insurance and patient refund requests, complete refund paperwork, and prepare refund requests for management approval
- Process credits, adjustments, and write-offs in accordance with approval guidelines
- Escalate seriously delinquent patients accounts to management for review, including referral to third-party collections, in accordance with clinic policy and applicable law
- Document changes in insurance, billing systems, and clearinghouses to maintain an accurate audit trail
- Post insurance payments in a timely manner (within 2 business days) and ensure all payments are posted for month-end close
- Register online with insurance carriers to obtain claim and eligibility information via the web
- Responsible for the generation and mailing of claims