Patient Benefit Representative

The US Oncology Network•Washington, DC

3d•Onsite

About The Position

The Patient Benefit Representative works under general supervision to educate patients about insurance coverage and benefits, assess patients’ financial ability, and provide information about assistance programs. The role updates and maintains patient insurance eligibility, coverage, and benefits in the system, and supports the US Oncology Compliance Program, including its Code of Ethics, Business Standards, and Shared Values. Before treatment, the representative obtains insurance and demographic information; explains coverage, benefits, co-pays, deductibles, and out-of-pocket expenses; discusses payment arrangements; and may identify financial assistance programs and help patients complete forms. The representative prepares patient cost estimates and reimbursement and liability forms, forwards relevant information to the billing office, and obtains required pre-authorization or referral approval codes from a Clinical Reviewer. At each visit, the representative verifies and updates patient information, confirms that co-pay amounts are entered or conveyed correctly, reviews account balances, and notifies the front desk when patients should meet with staff. The role also maintains knowledge of financial assistance resources, required documentation, and applicable confidentiality and privacy requirements.

Requirements

Possess current knowledge of the profession and industry and use expert resources when appropriate.
Adapt to day-to-day challenges, shifting priorities, ambiguity, rapid change, and adversity.
Make timely, cost-effective, and sound decisions, including under uncertainty.
Set high performance standards, pursue goals, and work efficiently.
Emphasize and deliver quality services, evaluate work against quality standards, and improve efficiency.
Be present at the employee site during regularly scheduled business hours.
Meet the physical demands of the role, including sitting or standing, talking or hearing, extensive standing and walking, and occasionally lifting or carrying items weighing up to 40 pounds.

Responsibilities

Obtain insurance coverage information and patient demographics before treatment.
Educate patients about insurance coverage, benefits, co-pays, deductibles, and out-of-pocket expenses.
Assess patients’ ability to meet expenses and discuss payment arrangements.
Explain financial assistance programs, identify assistance sources, and help patients complete forms when appropriate.
Complete Patient Cost Estimate forms based on diagnosis, estimated insurance coverage, and financial assistance.
Complete reimbursement and liability forms for patient review and signature, and forward appropriate information and forms to the billing office.
Obtain insurance pre-authorization or referral approval codes from the Clinical Reviewer before each treatment.
Review patient account balances and notify the front desk of patients who should meet with staff.
Ensure patient co-pay amounts are correctly entered into the system or conveyed so the front desk can collect them.
Verify and update patient demographics and insurance coverage in the computer system at each visit according to standard operating procedures.
Stay current on financial assistance resources and develop professional relationships with assistance providers to obtain leads to other programs.
Protect patient records in accordance with confidentiality requirements and applicable state and federal laws and guidelines.
Maintain updated manuals, logs, forms, and documentation.
Perform additional duties as requested or assigned.