Physician Billing Rep

Job Details

Physician Billing Representative

Job Description

PRIMARY RESPONSIBILITIES:

The Billing Coordinator for Oncology is responsible for securing timely and accurate insurance authorizations and reauthorizations for outpatient infusion services. This role ensures that all required clinical and administrative documentation is obtained, verified, and submitted to payers to facilitate patient access to treatment without delays. The specialist serves as a key liaison between the clinical team, patients, and insurance providers, verifying that all payer requirements are met prior to scheduled infusions.

Additional responsibilities include tracking authorization statuses, following up on outstanding requests, resolving payer inquiries, and supporting the clinical and billing teams to maintain accurate records. The role requires staying current on insurance policies, payer requirements, and regulatory guidelines to ensure compliance and smooth patient care coordination.

The Billing Coordinator works with the Billing Manager and Business Manager to ensure adherence to all regulatory and HIPAA guidelines.

ESSENTIAL FUNCTIONS:

• Review and process infusion referrals by verifying patient insurance coverage and benefits and obtaining prior authorizations for infusion medications and services.
• Collaborate with internal teams including providers, case managers, pharmacy, and billing to ensure accurate clinical documentation and resolve any issues related to authorizations or claim denials.
• Track and manage authorization workflows by monitoring pending requests, appealing denials as needed, and ensuring timely follow-up to avoid treatment delays.
• Maintain accurate records of all authorization activities and communications in the electronic health record (EHR) or designated systems.
• Ensure compliance with payer requirements, HIPAA regulations, and internal protocols while consistently demonstrating professionalism and the hospital's core values in all interactions.

EDUCATIONAL/TRAINING REQUIREMENTS:

High School Diploma

Must pass all required training for EPIC

CERTIFICATES, LICENSES, AND REGISTRATION:

N/A

EXPERIENCE REQUIREMENTS: Must be experienced with Excel or complete courses offered by Jefferson IT within two months

Work Shift

Weekend Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Abington Memorial Hospital

Primary Location Address

925 Chestnut Street, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students.