Physician Billing Specialist

Position Overview: As a Physician Billing Specialist for Perioperative Services, you will be responsible for the training and development initiatives and reporting within billing and reimbursement processes associated with physician services related to surgery, anesthesia and pain medicine, critical care and psychiatry. You will work closely with your Manager and Director, the Perioperative Services physicians, and physician billing professionals to ensure accurate billing and timely reimbursement for services rendered, while also leading training efforts and facilitating reporting activities. This role requires strong knowledge of MOH Schedule of Benefits, regulations and billing practices, previous physician billing experience min 5 years (Surgical; Anesthesia or Critical Care preferred), great attention to detail, and the ability to collaborate effectively with the billing team.

Role Description: We are seeking a highly organized, self-motivated and detail-oriented individual to join our team in the role of Physician Billing Specialist. This position requires a unique blend of skills encompassing both MOH billing procedures and regulations. The ideal candidate will be proficient in financial reporting medical coding, and billing practices within the healthcare industry.

Here's What You'll Get To Do:

• Review physician billing claims meticulously for completeness and accuracy, ensuring adherence to Ministry of Health submission deadlines.
• Validate claims by reviewing medical documentation and assigning appropriate billing codes to procedures and diagnoses in accordance with regulatory guidelines.
• Reconcile outstanding billing reports by cross-referencing pending visits with medical documentation, and proactively follow up with physicians to prevent outstanding claims from becoming stale dated.
• Investigate and resubmit errored and denied OHIP claims, initiate Remittance Advice Inquiries, and actively pursue maximizing revenue for departments. Monitor MOH responses and engage in follow-up communications to resolve outstanding issues.
• Offer billing expertise and provide educational support to inquiring physicians, and billers offering guidance on billing rules and general Epic physician workflows.
• Prepare billing claims for Reciprocal, IFHP, Quebec, International, Insurance, and Self-Pay categories.
• Lead and develop the training materials, manuals and responsible to keep it up to date, implement changes in Epic based on MOH Bulletins and changes.
• Assist manager in reviewing MOH Bulletins and implement changes on the internal billing processes. Reviewing Codes and updating it in EPIC if needed
• Participate in departmental meetings to review billing workflows and processes.
• Collaborate with the Ministry of Health and other insurance agencies on charges and payments, interpreting fee code schedules and providing advice and recommendations to faculty and Division Heads.
• Assist manager on weekly/monthly MOH claim submission, RA error reports when needed.
• Conduct regular audits and run reports to identify billing errors and implement corrective actions, fostering working relationships with multiple physicians, Epic analysts, and clinical operations teams to support registration and billing workflows.
• Assist manager on monthly and adhoc billing reports submission and presentations.
• Analyze reports independently and follow up with faculty on findings and resolutions if needed, reconciling EPIC billings with Ministry of Health reports, and continually striving for process improvement as EPIC evolves.
• Assist manager with Month End and other billing reports and analyze key performance indicators to track departmental performance and identify areas for improvement.
• Support/Educate Physicians and Epic analysts in all billing matters if needed.
• Participate in divisional meetings, training sessions, and quality improvement initiatives as required.
• Maintain strict patient confidentiality and adhere to PIPEDA (Personal Information Protection and Electronic Documents Act) regulations.
• Other tasks and duties as assigned by manager.

Here's What You'll Need:

• Bachelor's degree in healthcare administration, finance, business, or related field or combination of education and experience (enrolment in CPA or an MBA is considered an asset).
• Minimum of five years of previous experience in physician billing (Surgical, Anesthesia or Critical Care preferred), coupled with a university degree.
• Excellent computer and keyboarding skills, with a strong knowledge of Microsoft Office Suite
• Microsoft Excel- advance level preferably, and experience with larger database and reporting tools.
• Experience working with EMR or EHR, medical billing software (Epic preferred).
• Comprehensive knowledge and understanding of the rules and application of the MOH OHIP Schedule of Benefits.
• Excellent analytical and problem-solving abilities, with focus on continuous improvement.
• Ability to interpret complex medical documentation.
• Detail-oriented and organized, with the commitment to accuracy and compliance.
• Ability to prioritize tasks and manage multiple deadlines in a fast-paced environment.
• Effective communication skills, both written and verbal, with the ability to interact professionally with physicians, staff and team members.
• Demonstrated commitment and actions in advancing equity, diversity and inclusion objectives

Here's What You'll Love:

• Enhancing children's health and changing the lives of children and their families every day
• A focus on employee wellness with our new Staff Health and Well-being Strategy. Self-care helps us support others
• A hospital that welcomes and focuses on Equity, Diversity, and Inclusion.
• The opportunity to make an impact. Regardless of your role or professional interest, you'll be making a difference at SickKids and contributing to our vision of Healthier Children. A Better World.
• Comprehensive health & dental benefits and a defined-benefit pension plan
• An academic and learning environment, awards and bursaries, mentoring programs, and a focus on continuous improvement.

Employment Type: Full-time Permanent, 1.0 FTE