Dedicated exclusively to children and their families, The Hospital for Sick Children (SickKids) is one of the largest and most respected paediatric healthcare centres in the world. As innovators in child health, we lead and partner to improve the health of children through the integration of healthcare, leading-edge research and education. Our reputation would not have been built - nor could it be maintained - without the skills, knowledge and experience of the extraordinary people who come to work here every day. SickKids is committed to ongoing learning and development, and features a caring and supportive work environment that combines exceptionally high standards of practice.
When you join SickKids, you become part of our community. We share a commitment and determination to fulfill our vision of
Healthier Children. A Better World.
Don't miss out on the opportunity to work alongside the world's best in paediatric healthcare.
Position Overview: Are you billing professional fees for physician services in the province and looking to further develop your expertise as a specialist? The SickKids Peri-Operative Services Professional Billing Team is looking for a Physician Billing Specialist to play a strategic role supporting the Senior Manager, Business Operations, to execute strategic priorities related to professional billing activities.
As a Physician Billing Specialist for Peri-Operative Services, you will be responsible for training and development initiatives, reporting and reimbursement processes associated with physician services. In this role you will support the following physician groups: surgery, anesthesia and pain medicine, critical care medicine, psychiatry and diagnostic and interventional radiology. You will work closely with your Manager and the Director, the physicians in Perioperative Services and the professional billing team to ensure accurate billing and timely reimbursement for services rendered, while also leading training efforts and facilitating reporting activities. This role requires a minimum of 3-5 years of physician billing experience, and while it is preferred that the successful candidate will have experience in at least one of either surgery, anesthesia or critical care, it is not necessary. A strong working knowledge of the MOH Schedule of Benefits, regulations and billing practices is required. The successful candidate will be a life-long learner, will have a natural curiosity and interest in continuous process improvement, and will manage pressures related to accuracy, tight deadlines and customer service.
Role Description
We are seeking a highly organized, self-motivated and detail-oriented individual to join the Professional Billing team as a Physician Billing Specialist. This position requires a strong combination of physician billing expertise, knowledge of MOH/OHIP billing requirements, analytical and reporting capabilities, and an understanding of clinical and professional billing workflows within a complex healthcare environment.
Here's What You'll Get To Do
- Review physician billing claims for completeness and accuracy, ensuring compliance with Ministry of Health requirements and claim submission deadlines.
- Validate claims by reviewing medical documentation and identifying appropriate billing and diagnostic codes in accordance with applicable billing rules and guidelines.
- Reconcile outstanding billing reports by cross-referencing pending visits and services with available medical documentation and proactively follow up with physicians to reduce outstanding and stale-dated claims.
- Investigate errored and denied OHIP claims, complete appropriate corrections and resubmissions, initiate Remittance Advice Inquiries where required, monitor MOH responses, and follow up on outstanding billing issues.
- Provide billing expertise, education and guidance to physicians and billing staff regarding MOH/OHIP billing rules and Epic professional billing workflows.
- Prepare and process physician billing claims for Reciprocal, IFHP, Quebec, International, Insurance and Self-Pay payer categories.
- Lead the development and maintenance of training materials, billing manuals, tip sheets and other resources to support consistent and high-quality professional billing practices across the team.
- Support the Manager in reviewing MOH Bulletins, Schedule of Benefits updates and other billing changes, assessing operational impacts and implementing required changes to internal billing processes.
- Review billing codes and support corresponding updates within Epic Resolute Professional Billing, as required.
- Participate in departmental and divisional meetings to review billing workflows, operational issues and opportunities for improvement.
- Collaborate with the Ministry of Health and other applicable payers on billing, claims and payment matters, interpreting fee schedules and providing billing guidance to physicians and Division Heads.
- Support weekly and monthly MOH claim submission activities and review Remittance Advice error and rejection reports as required.
- Conduct regular billing audits and reporting to identify errors, trends and opportunities for corrective action and process improvement.
- Develop effective working relationships with physicians, Epic analysts, clinical operations teams and other stakeholders to support registration, documentation and professional billing workflows.
- Support the Manager with monthly and ad hoc billing reports, analysis and presentations.
- Independently analyze billing reports, identify issues and trends, and follow up with physicians and other stakeholders on findings and required resolutions.
- Reconcile Epic professional billing activity with Ministry of Health payment and remittance information and identify opportunities for continuous improvement as Epic workflows evolve.
- Support month-end billing activities and reporting, including analysis of key performance indicators to identify trends and opportunities for improvement.
- Provide education and subject-matter support to physicians, billing staff and Epic analysts on physician billing matters, as required.
- Participate in divisional meetings, training sessions and quality-improvement initiatives.
- Maintain strict patient confidentiality and comply with Ontario's Personal Health Information Protection Act, 2004 (PHIPA) and applicable SickKids privacy and confidentiality requirements.
- Perform other related duties as assigned by the Manager.
Here's What You'll Need
- Bachelor's degree in healthcare administration, finance, business or a related field, or an equivalent combination of education and relevant experience.
- Minimum of five years of physician billing experience, with experience in surgical, anesthesia, pediatric or critical care billing considered an asset.
- Experience working in a hospital or academic health centre environment is strongly preferred.
- Strong working knowledge and practical application of the Ontario MOH/OHIP Schedule of Benefits, billing rules, regulations and physician billing practices.
- Experience working with EMR/EHR and physician billing systems. Epic experience is preferred, particularly Epic Resolute Professional Billing.
- Demonstrated experience reviewing physician documentation and applying appropriate billing and diagnostic codes.
- Experience with physician billing reconciliation, claim errors and rejections, Remittance Advice reporting and reimbursement processes.
- Strong analytical and reporting skills, including the ability to interpret billing data, identify trends and investigate discrepancies.
- Advanced proficiency in Microsoft Excel is preferred, along with experience working with large datasets, databases and reporting tools.
- Excellent computer skills and proficiency with Microsoft Office applications.
- Strong analytical, critical-thinking and problem-solving skills with a focus on continuous improvement.
- Ability to interpret complex medical and clinical documentation in support of accurate physician billing.
- Exceptional attention to detail and a demonstrated commitment to billing accuracy, compliance and data integrity.
- Ability to prioritize competing responsibilities and meet multiple deadlines in a fast-paced healthcare environment.
- Excellent written and verbal communication skills, with the ability to work effectively and professionally with physicians, clinical teams, billing staff, leadership and other stakeholders.
- Strong organizational skills and the ability to work both independently and collaboratively within a multidisciplinary environment.
Here's What You'll Love
- This position is eligible for employee benefits coverage including but not limited to; health, dental and life insurance. The full benefits package will be discussed at the time of offer.
- This position is eligible to enroll in the Healthcare of Ontario Pension Plan (HOOPP). You can learn more about HOOPP's plan features by reviewing The HOOPP Handbook.
- 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 will be making a difference at SickKids and contributing to our vision of Healthier Children. A Better World.
- For more on why you'll love working at SickKids, visit our careers site.
Employment Type
- Temporary, 18-month contract
- 35 hours per week
- Hybrid working arrangement
SickKids is committed to championing equity, diversity and inclusion in all that we do, fostering an intentionally inclusive and culturally safe environment that reflects the diversity of the patients, families and communities we serve. Learn more about workplace inclusion.
If you require accommodation during the application process, please reach out to our aSKHR team. SickKids can provide access and inclusion supports to eligible candidates to support their full engagement during the interview and selection process as well as to ensure candidates are able to perform their duties once successfully hired. If you are invited for an interview and require accommodation, please let us know at the time of your invitation to interview. Information received related to access, inclusion or accommodation will be addressed confidentially.
Technical difficulties? Email ask.hr@sickkids.ca with a short description of the issues you are experiencing. We will not accept resumes sent to this inbox but we are happy to respond to requests for technical assistance.
Tip: Combine your cover letter and resume into
ONE document of 20 pages or less as you cannot upload multiple documents as part of your application.
Every application is reviewed by a human recruiter and all hiring decisions are made by people. In some cases, AI-assisted tools are used to help review applications based on job-related qualifications.
All positions posted on the SickKids Hospital's Careers Site represent current vacancies, unless otherwise posted in the job description.
