Role Summary
The OHIP Billing Expert supports the clinic’s financial and administrative operations by ensuring accurate and timely submission of OHIP and third-party claims. This role involves processing physician billings, reviewing patient records, resolving claim discrepancies, maintaining compliance with healthcare regulations, and managing accounts receivable and payable. The position also utilizes QuickBooks for bookkeeping, payment tracking, account reconciliation, and financial record maintenance. Working closely with physicians and administrative staff, the OHIP Billing Expert helps ensure efficient billing processes, financial accuracy, and smooth clinic operations.
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Role Responsibilities
- Process and submit accurate OHIP and third-party medical claims in accordance with provincial billing guidelines.
- Review patient charts, physician notes, and supporting documentation to ensure billing accuracy and completeness.
- Verify patient health card information, eligibility, and insurance details prior to claim submission.
- Investigate and resolve rejected, pending, or disputed claims with physicians, insurers, and regulatory bodies.
- Maintain accurate billing records, financial documentation, and reconciliation reports using QuickBooks and other billing systems.
- Manage accounts receivable and payable activities, including payment tracking, invoice processing, and account reconciliation.
- Monitor outstanding claims, patient balances, and reimbursements, and follow up on overdue payments.
- Prepare billing summaries, financial reports, account statements, and month-end reconciliation reports as required.
- Record and reconcile financial transactions in QuickBooks to ensure accuracy of clinic accounts and financial records.
- Ensure compliance with OHIP regulations, healthcare billing standards, privacy legislation, and internal financial policies.
- Collaborate with physicians, management, and administrative staff to support efficient billing operations and revenue cycle management.
- Assist with audits by providing billing, accounting, and financial documentation as required.
- Maintain confidentiality and uphold ethical standards when handling patient, billing, and financial information.
- Stay current with OHIP billing codes, fee schedules, accounting procedures, and regulatory changes.
- Provide guidance and support to administrative staff regarding billing, documentation, and financial processes.
- Perform other related billing, accounting, and administrative duties as assigned.
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Qualifications
Formal Education or Equivalent
- Diploma or Bachelor’s degree in Healthcare Administration, Medical Office Administration, Health Information Management, Accounting, Business Administration, Finance, or a related field.
- Certification or formal training in OHIP billing, medical billing, healthcare administration, bookkeeping, accounting, or QuickBooks is considered an asset.
- Experience using QuickBooks, medical billing software, and financial management systems is preferred.
- Strong understanding of OHIP billing procedures, healthcare regulations, accounting principles, and financial record management is an asset.
Certifications (Preferred)
- Certification in Medical Billing and Coding, OHIP Billing, Bookkeeping, Accounting, or QuickBooks is preferred.
- Knowledge of Ontario healthcare billing regulations, OHIP schedules, claim submission processes, accounting principles, accounts receivable/payable, and financial reconciliation procedures is an asset.
- Proficiency in QuickBooks, medical billing software, and Microsoft Office applications is considered an asset.
- WHMIS, privacy/confidentiality, and financial compliance training certifications are considered an asset.
Experience
- 0–2 years of experience in OHIP billing, medical billing, healthcare administration, bookkeeping, accounting, or a medical office setting (co-op/internship experience considered).
- Basic knowledge of OHIP billing procedures, medical terminology, healthcare documentation, bookkeeping, and accounting principles.
- Familiarity with EMR systems, claim submission processes, billing reconciliation, accounts receivable/payable, QuickBooks, and Ontario healthcare regulations is an asset.
- Experience maintaining financial records, tracking payments, and preparing basic financial reports is considered an asset.
Skills & Competencies
- Strong attention to detail and accuracy in OHIP billing, accounting transactions, bookkeeping, and financial record management.
- Ability to work efficiently in a fast-paced healthcare environment while managing multiple billing and accounting priorities.
- Excellent organizational, time management, and record-keeping skills.
- Strong communication, interpersonal, and teamwork abilities when working with physicians, patients, management, and administrative staff.
- Proficiency in EMR systems, medical billing software, QuickBooks, and Microsoft Office applications.
- Sound knowledge of OHIP billing procedures, healthcare documentation standards, accounting principles, and confidentiality requirements.
- Strong analytical, problem-solving, and reconciliation skills with the ability to identify and resolve billing and financial discrepancies.
- Ability to maintain professionalism, accuracy, and confidentiality when handling sensitive patient and financial information.
- Capability to work independently and collaboratively within an interdisciplinary healthcare team while supporting billing, accounting, and administrative functions.
