Accounting and OHIP Billing Coordinator

Position Summary The Accounting and OHIP Billing Coordinator is responsible for the accurate management of all financial transactions, OHIP billings, private patient billings, accounts receivable, accounts payable, payroll support, physician remittances, reconciliation processes, and financial reporting within the clinic. The role ensures compliance with Ontario Health Insurance Plan (OHIP) billing regulations, Ministry of Health requirements, clinic policies, and financial controls. This position plays a critical role in maintaining the financial health of the organization through accurate billing, revenue cycle management, auditing, and reporting. Key Responsibilities
1. OHIP Billing Management Daily Responsibilities

• Submit physician billings to OHIP accurately and within prescribed timelines.
• Verify all patient demographics and health card information before claim submission.
• Review physician encounter notes to ensure billing accuracy and completeness.
• Process same-day submissions and resubmissions of rejected claims.
• Monitor billing queues and outstanding claims.
• Identify missing documentation affecting billings.
• Verify appropriate billing codes are applied according to current OHIP Schedule of Benefits.

Weekly Responsibilities

• Review rejected claims reports.
• Correct and resubmit billing errors.
• Audit physician billings for completeness.
• Reconcile submitted claims against appointments completed.
• Follow up on unresolved billing issues.

Monthly Responsibilities

• Review OHIP remittance advice statements.
• Reconcile payments received from the Ministry of Health.
• Analyze billing trends and discrepancies.
• Generate physician billing reports.
• Identify opportunities for revenue optimization.
  

2. Fertility and Gynecology Billing

• Process billing for:
  • Fertility consultations
  • Cycle monitoring
  • IUI procedures
  • Semen analysis
  • Sperm wash procedures
  • IVF coordination services
  • Private fertility services
  • Gynecology consultations
  • Ultrasound procedures
  • Endometrial biopsies
  • Sonohysterograms
  • IUD insertions/removals
  • Nexplanon insertions/removals
  • Obstetrical ultrasounds
  • Diagnostic imaging services
• Ensure funded IVF/FET cycles are appropriately flagged and not incorrectly billed.
• Monitor private-pay services and ensure payment collection.
• Verify package payments and treatment plans.
  

3. Private Billing Administration

• Generate private patient invoices.
• Process patient payments.
• Issue receipts and maintain payment records.
• Manage payment plans and outstanding balances.
• Follow up on overdue accounts.
• Process refunds when approved.
• Reconcile daily sales reports.
  

4. Accounts Receivable

• Monitor all incoming payments.
• Track unpaid patient accounts.
• Investigate billing discrepancies.
• Prepare aging reports.
• Follow up with patients, insurers, and third-party payers.
• Ensure timely collection of outstanding balances.
  

KPI

• Accounts Receivable aging maintained below 60 days.
• Collection rate above 95%.
  

5. Accounts Payable

• Receive and review vendor invoices.
• Match invoices against purchase orders.
• Verify approvals prior to payment.
• Prepare payment schedules.
• Process vendor payments.
• Maintain vendor records.
• Reconcile supplier statements.
  

Vendors May Include

• Medical supply companies
• Laboratory vendors
• Pharmaceutical suppliers
• Equipment providers
• Utility providers
• Professional services
  

6. Bank Reconciliation

• Reconcile bank statements.
• Investigate discrepancies.
• Balance daily deposits.
• Reconcile credit card transactions.
• Verify EFT transactions.
• Monitor cash flow.
  

7. Payroll Support

• Review employee timesheets.
• Verify hours worked.
• Track overtime.
• Assist with payroll processing.
• Maintain payroll records.
• Coordinate with payroll providers (e.g., ADP).
• Ensure compliance with employment standards.
  

8. Financial Reporting Prepare: Daily Reports

• Daily revenue reports
• Daily sales reports
• Payment summaries

Weekly Reports

• Revenue analysis
• Billing productivity reports
• Outstanding account reports

Monthly Reports

• Profit and loss summaries
• Revenue by physician
• Revenue by clinic location
• Accounts receivable aging reports
• Billing rejection reports
• Inventory expenditure reports

9. Audit and Compliance

• Conduct internal billing audits.
• Maintain OHIP compliance.
• Ensure compliance with:
  • Ontario Ministry of Health regulations
  • CPSO standards
  • PHIPA requirements
  • CRA requirements
  • Corporate financial policies
• Participate in external audits.
• Maintain audit-ready records.

10. Inventory Financial Tracking

• Verify medication invoices.
• Track medication purchases.
• Monitor inventory expenditures.
• Reconcile inventory counts with purchases.
• Investigate discrepancies.
• Support annual inventory audits.

11. EMR and Financial Systems Management Systems May Include

• OSCAR EMR
• Accuro EMR
• QuickBooks
• ADP Payroll
• Excel
• Ministry of Health Billing Portals

Responsibilities:

• Maintain accurate billing records.
• Generate reports.
• Ensure data integrity.
• Support system troubleshooting.

Required Qualifications Education

• Diploma or Degree in:
  • Accounting
  • Finance
  • Business Administration
  • Health Information Management
  • Medical Office Administration

Experience

• Minimum 2 years of medical billing experience.
• Experience with OHIP billing required.
• Experience in fertility, gynecology, diagnostic imaging, or specialty clinics preferred.
• Experience with QuickBooks and EMR systems preferred.

Required Skills Technical Skills

• OHIP billing knowledge
• Medical terminology
• Accounts payable and receivable
• Payroll support
• Financial reconciliation
• Microsoft Excel
• Financial reporting
• QuickBooks and Erplain

Professional Skills

• Strong attention to detail
• Excellent organizational skills
• Ability to work independently
• Strong analytical skills
• Confidentiality and professionalism
• Time management
• Problem-solving skills

Key Performance Indicators (KPIs)  OHIP claim acceptance rate >98% Billing submission timeliness 100% Rejected claim resolution Within 5 business days Accounts receivable over 60 days < 5% Monthly bank reconciliation completion 100% Vendor payment accuracy 100% Daily sales reconciliation accuracy 100% Financial report submission On time Payroll accuracy 100% Patient billing collection rate >95%