Physician Billing Rep

Jefferson Health Plans • Philadelphia, PA

4d • Onsite

About The Position

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.

Requirements

• High School Diploma
• Must pass all required training for EPIC
• Must be experienced with Excel or complete courses offered by Jefferson IT within two months

Responsibilities

• Securing timely and accurate insurance authorizations and reauthorizations for outpatient infusion services.
• Ensuring all required clinical and administrative documentation is obtained, verified, and submitted to payers.
• Serving as a key liaison between the clinical team, patients, and insurance providers.
• Verifying that all payer requirements are met prior to scheduled infusions.
• Tracking authorization statuses and following up on outstanding requests.
• Resolving payer inquiries.
• Supporting the clinical and billing teams to maintain accurate records.
• Staying current on insurance policies, payer requirements, and regulatory guidelines.
• 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.

Benefits

• Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.
• Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.
• All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

What This Job Offers

• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees