Billing Specialist

Company Overview

Sage Fertility is an elite fertility practice dedicated to exceptional clinical outcomes and an outstanding patient experience. Guided by our shared vision, mission, and values, we strive to expand access to fertility care, deliver best-in-class results, and support patients on their journey to building a family.

Position Summary

We are seeking a detail-oriented and knowledgeable Billing Specialist to manage insurance claims and collections, resolve accounts receivable issues, and support patient collections for our fertility practice. This role involves detailed research and follow-up on medical insurance claims, preparing appeals, and working closely with insurance carriers, patients, and internal teams to drive timely and accurate collections. The specialist will collaborate with staff and management to help meet organizational billing and collection goals on a daily, weekly, monthly, and yearly basis. This is a fully remote position. 

Responsibilities

• Review outstanding claims to determine what action needs to take place, 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
• 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

Qualifications

• 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

Attributes

• Highly process-oriented and detail-focused
• Excellent interpersonal, communication, and customer service skills with staff and patients
• Empathy and discretion when discussing sensitive financial and family-building matters
• Firm, professional, and confident handling of past-due balances
• Dependable, reliable team player who can also work independently
• Goal-oriented with a positive attitude
• Able to troubleshoot and resolve ongoing problems
• Able to handle stressful situations while maintaining professionalism and composure
• Builds strong working relationships with patients, management, physicians, and internal teams

Ivy Fertility is an equal opportunity employer. Employment decisions are based on merit, qualifications, performance, and business needs. Ivy Fertility does not discriminate on the basis of race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, sex, sexual orientation, gender identity or expression, veteran status, or any other status protected by applicable federal, state, or local law.