Inception Fertility

Medical Billing and Coding

• The Medical Billing Specialist is responsible for the timely and accurate submission of insurance claims, reviewing and updating denied claims for resubmission and performing reconciliations to ensure timely billing for services provided.
• The Medical Billing Specialist collaborates with patients, revenue cycle counterparts and work units, clinical staff, and insurance providers to drive the efficiency of the billing process and reduce the amount of denied claims.
• Reviews patient demographic and insurance information and confirms patient benefit details related to services provided by the clinic from insurance providers.
• Obtains necessary medical documentation from clinicians to provide to insurance companies as required for review and prior authorization of treatment.
• Documents authorization reference numbers in EMR and/or other systems.
• Updates and maintains EMR and/or other systems based on documentation provided by physician/clinic for creation of medical claim and/or posting of self-pay charges to patient accounts.
• Prepares electronic claim files for submission.
• Monitors accepted/denied claims and updates claims as required for resubmission.
• Compares transaction reports with daily schedules to ensure timely billing of all services provided each month.
• Resolves and prepares paperwork for any credit balances and prepares statements for collection of outstanding patient balances.
• Performs daily charge capture functions as outlined by each Clinic in a timely and appropriate manner. This includes but not limited to the actual data entry of charges per patient into the EMR platform, eIVF.
• Ensures charge reconciliation to the schedule for all patients seen daily.
• Ensures appropriateness of charges based upon services rendered and works in conjunction with Clinic leadership, RCM Leadership, and Coding Team to ensure such accuracy.

Medical Billing Specialist – Women's Health

Recruitment

• Review egg and sperm donor applications for eligibility in accordance with Prelude Network donor acceptance guidelines.
• Conduct initial screening interviews to evaluate applicants for the program.
• Explains donor program details and provides information to prospective donors via telephone, email, and virtual consultation.
• Establishes an ongoing relationship to encourage completion of the application and screening process.
• Coordinates genetic risk assessment and review with contracted Genetic Counselors and reviews all genetic reports prior to handoff to donor coordinators.
• Obtains necessary medical records to establish applicant eligibility for donation.
• Creates and maintains donor profiles in the donor database program and prepares applicants for handoff to donor coordinator.
• Collects and prepares applicant photos for sharing in their online donor profile.
• Responsible for donor profile preparation, reconciliation of information, and review before handoff to donor coordinator.
• Identifies inconsistencies in donor information and strives to maintain accurate data and records across all systems.
• Attends meetings to discuss applicant process/management; maintains relevant spreadsheets/documentation.
• Establish and maintain collaborative relationships with MySpermBank team, Central Donor Recruitment staff, Inception Corporate team and vendors, Prelude Network clinical and admin teams.
• Able to communicate, problem solve independently, and respond quickly to all key team members needs and inquiries.

Donor Recruiter – Fertility

Accounts Receivable

• The AR Specialist is responsible for billing and follow-up of accounts according to documented procedures.
• Includes but is not limited to: following up on claim status, billing and re-billing of claims, credit balance resolution, denial management, following up on aging accounts, and maintaining up to date account information.
• Monitors claim status and records in system daily for commercial insurance billing.
• Ensure timely collection of outstanding A/R and perform a variety of clerical and accounting functions to resolve billing issues of submitted claims
• Review EOBs, assist in verifying patient coverage if needed, and assist with patient billing inquiries through a billing queue
• Conducting outbound calls to insurance companies and/or patients to reconcile account issues and outstanding account balances
• Facilitates and initiates appeals to insurance companies for higher payments and other appeals as needed.
• Handles correspondence from payers to ensure all information required for claim processing is provided.
• Review and resolve credit balances or unassigned money remaining on an account.
• Provides customer service and follow through on account questions.
• Assists with Special Projects as needed.

Medical Billing Specialist – Women's Health

Donor Recruiter – Fertility

AR Specialist – Healthcare