Billing Specialist

Ivy Fertility•Saint Louis, MO

17d•Remote

About The Position

Sage Fertility is an elite fertility practice focused on clinical outcomes, patient experience, expanding access to fertility care, and supporting patients building a family. The Billing Specialist manages insurance claims and collections, resolves accounts receivable issues, and supports patient collections. The role involves researching and following up on medical insurance claims, preparing appeals, and working with insurance carriers, patients, staff, providers, and management to achieve timely and accurate collections and meet organizational billing and collection goals. The position is fully remote. The specialist reviews and follows up on outstanding claims, researches rejections and denials, corrects or resubmits claims, posts payments, manages patient balances and payment plans, and documents billing activity. The role also includes coding-related work, refunds and adjustments, reporting, compliance, and support for special projects. The position requires careful, professional handling of sensitive financial and family-building matters.

Requirements

Minimum of 2 years of direct medical billing, accounts receivable, or coding experience.
Working knowledge of medical accounts receivable, insurance and patient collections, claim rejections and denials, appeals, and related billing guidelines and policies.
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 and comparisons.
Strong knowledge of anatomy, physiology, and medical terminology.
Strong analytical and problem-solving skills, including the ability to identify root causes.
Effective, accurate, and concise verbal and written communication skills.
Ability to work independently and collaboratively as part of a team.
Strong attention to detail, prioritization, and multitasking skills in a fast-paced environment.
Strong customer service orientation and superior mathematical skills.
Proficiency in Excel and general computer systems and software.
Strong typing and 10-key speed and accuracy; minimum typing speed of 45 WPM.
Highly process-oriented and detail-focused, with strong interpersonal, communication, and customer service skills.
Empathy and discretion when discussing sensitive financial and family-building matters.
Ability to handle past-due balances firmly, professionally, and confidently.
Dependability and reliability as a team player who can also work independently.
Goal-oriented approach and positive attitude.
Ability to troubleshoot and resolve ongoing problems.
Ability to handle stressful situations with professionalism and composure.
Ability to build strong working relationships with patients, management, physicians, and internal teams.

Nice To Haves

Associate degree in Medical Billing, Accounts Receivable, or a related field preferred.
Fertility billing background preferred, but not required.
CPC certification preferred.
Experience in a medical office practice setting is ideal.

Responsibilities

Review outstanding claims, determine necessary action, and call insurance companies for status updates.
Research and resolve accounts receivable problems and disputed or delinquent balances with patients and insurance companies, including misapplied payments, direct deposits, and overpayments.
Request claim reprocessing or prepare and submit corrected claims when needed.
Research and resolve electronically submitted claim rejections and denials, including using payer websites to identify rejection reasons.
Report on and work insurance and patient accounts receivable over 45 days, documenting collection efforts.
Review prior collection efforts monthly to confirm payment was received.
Initiate collection actions on delinquent accounts through calls and correspondence with insurers and patients.
Contact patients about balances after insurance processing; send statements, reminders, and final notices on schedule.
Set up and monitor patient payment plans and auto-pay enrollments in accordance with clinic policy.
Accurately and promptly post patient payments by credit card, ACH, check, or cash.
Answer patient billing inquiries, explain carrier claim processing, and provide documentation such as EOBs and patient ledgers upon request.
Update demographic and payer information obtained from patients.
Research insurance and patient refund requests, complete refund paperwork, and prepare requests for management approval.
Process credits, adjustments, and write-offs in accordance with approval guidelines.
Escalate seriously delinquent patient accounts to management, including possible 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 within two business days and ensure all payments are posted for month-end close.
Register online with insurance carriers to obtain claim and eligibility information.
Generate and mail claims.
Work with team members, providers, and management on appeals and insurance denials.
Inform management of insurance changes or trends that could affect claim submission and processing.
Assign and verify diagnosis and procedure codes using ICD, HCPCS, and CPT systems, ensuring accuracy and correct sequencing under government and insurance regulations.
Follow up with providers about insufficient or unclear documentation and communicate with clinical staff regarding documentation.
Maintain compliance with medical coding policies, HIPAA, PCI standards, and billing and collection regulations, including FDCPA and state law.
Support management on special projects and prepare reports as requested.
Perform other duties as assigned.