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
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Work directly with team members, providers, and management on appeals and denials from insurance payors
Inform management of insurance changes or trends that could affect claims submission and processing
Assign and verify diagnosis and procedure codes using ICD, HCPCS, and CPT coding systems, ensuring accuracy and correct sequencing in accordance with government and insurance regulations
Follow up with providers on documentation that is insufficient or unclear, and communicate with clinical staff regarding documentation
Ensure ongoing compliance with medical coding policies, HIPAA, PCI standards, and billing/collection regulations (e.g., FDCPA and state law)
Support management on special projects and prepare reports as requested
Perform other duties as assigned
Requirements
Associate degree in Medical Billing, Accounts Receivable, or related field preferred
Minimum of 2 years of direct medical billing/accounts receivable/coding experience, ideally in a medical office practice setting (fertility billing background preferred but not required)
CPC certification preferred
Working knowledge of medical accounts receivable, insurance and patient collections, rejects, denials, appeals, and related billing guidelines and policies
Demonstrated knowledge of CPT, ICD-10, and HCPCS coding
Familiarity with medical insurance terminology and third-party payer reimbursement policies and procedures, including reimbursement reductions and fee schedule calculations/comparisons
Strong knowledge of anatomy, physiology, and medical terminology
Strong analytical and problem-solving skills, with the ability to identify root causes of issues
Ability to communicate effectively, accurately, and concisely, both verbally and in writing
Ability to work independently and collaboratively as part of a team
Highly detail-oriented with strong prioritization and multi-tasking skills in a fast-paced environment
Strong customer service orientation
Superior mathematical skills
Proficient in Excel and general computer systems/software
Strong typing and 10-key speed and accuracy (minimum 45 WPM typing)
Ability to establish and monitor performance/productivity standards
About the Company
Sage Fertility is an elite fertility practice dedicated to exceptional clinical outcomes and an outstanding patient experience. Guided by its shared vision, mission, and values, it strives to expand access to fertility care, deliver best-in-class results, and support patients on their journey to building a family. Ivy Fertility is an equal opportunity employer.
Ivy Fertility is a fertility services organization with fertility centers in California, Utah, Washington, Nevada, Idaho, Tennessee, Texas, Virginia and New York..
