Union: CUPE Clerical bargaining unit
Number of vacancies:  1
New or Replacement Position: Replacement
Site: Toronto General Hospital
Department:  Nephrology
Reports to:  Physician
Hours: 37.5 hours per week
Wage Range: $23.14 - $28.92 per hour
Shifts: Days
Status: Permanent Full-Time
Closing Date: October 19, 2026

Job Summary

As an integral member of the Division of Nephrology, the Billing Specialist is responsible for the accurate and timely preparation, submission, reconciliation, and monitoring of physician billings related to inpatient and outpatient nephrology services. The candidate will provide specialized support for hemodialysis, transplant, and ambulatory nephrology billing activities across multiple sites and satellite dialysis centres.

The Billing Specialist attends daily morning report meetings to identify billable encounters, gather information regarding patient care activities, and ensure complete capture of physician services. Responsibilities include reviewing clinical documentation within the electronic medical record, generating physician billings using approved Ontario billing software, identifying billing opportunities, resolving discrepancies, maintaining billing records, and providing reports to Division leadership.

The candidate is expected to maintain current knowledge of Ontario Health Insurance Plan (OHIP) billing requirements, nephrology-specific fee codes, and applicable Ministry of Health policies.

Duties

Inpatient Billing

• Attends daily handover meetings to maintain accurate records of billable MD clinical activities. 
• Generates and submits physician billings for inpatient nephrology services, including transplant.
• Reviews clinical documentation and patient encounters to ensure completeness and accuracy of submitted claims.
• Verifies patient lists and physician and team assignments.
• Identifies missing documentation and follows up with physicians to obtain required information.
• Submitted billing optimizes resources while remaining in keeping with the most current MOHLTC/OHIP regulations

OUTPATIENT HEMODIALYSIS BILLING

• Generates physician billings for outpatient hemodialysis services at Toronto General Hospital and affiliated programs – satellite and off site outpatient units.
• Maintains records of patient encounters and physician coverage assignments.
• Ensures accurate billing according to applicable nephrology and dialysis fee schedules.

AMBULATORY AND CLINIC BILLING

• Supports MD administrative assistants through ongoing review of their outpatient billing activities and assurance of timely reconciliation of errors.
• Available to support skill building of administrative assistants to utilize new software, understand new OHIP policies and codes, and improve efficiencies

CLINICAL DOCUMENTATION REVIEW

• Attends daily nephrology morning report and clinical handover sessions to identify billable services and physician assignments.
• Reviews patient encounters documented in Epic and other approved clinical systems.
• Searches and reviews clinical records, consultation notes, progress notes, dialysis records, and discharge summaries necessary for billing purposes.
• Verifies service dates, locations, providers, and patient eligibility information.
• Identifies incomplete or inconsistent documentation and follows up with clinical staff.

BILLING RECONCILIATION AND QUALITY ASSURANCE

• Reviews submitted claims and payment reports to identify discrepancies, rejected claims, underpayments, and unpaid accounts.
• Investigates billing irregularities and recommends corrective actions.
• Maintains tracking systems for submitted claims, corrections, and resubmissions.
• Produces regular billing activity reports and summary statistics for physicians and Division leadership.
• Assists with audits and reporting requirements.

BILLING SYSTEMS AND DATABASE MANAGEMENT

• Utilizes Ontario and UHN approved physician billing software to generate and track physician claims.
• Maintains accurate electronic billing records and databases.
• Generates routine and ad hoc reports regarding billing activity, revenue trends, physician service volumes, and claim status.
• Assists in identifying opportunities to improve billing workflows and operational efficiency.

LIAISON WITH PHYSICIANS AND CLINICAL STAFF

• Serves as a resource to physicians and administrative assistants regarding billing requirements and documentation standards.
• Communicates in a professional and confidential manner regarding patient and physician information.
• Facilitates timely resolution of billing-related inquiries.

ONGOING PROFESSIONAL DEVELOPMENT

• Maintains current knowledge of:
  • OHIP billing regulations
  • Ontario Schedule of Benefits
  • Nephrology and transplant fee codes
  • Dialysis billing requirements
  • Transplant billing requirements
  • Virtual care billing regulations
  • Ministry of Health policy updates
• Participates in relevant education sessions and professional development activities.