Patient Benefit Representative

The US Oncology Network•Silver Spring, MD

19d•Onsite

About The Position

Under general supervision, the Patient Benefit Representative educates patients about insurance coverage and benefits, assesses their financial ability to meet expenses, and may provide information about assistance programs. The representative updates and maintains patient insurance eligibility, coverage, and benefit information in the system, and supports the US Oncology Compliance Program, Code of Ethics and Business Standards, and Shared Values. Before a patient’s first appointment, the representative obtains preliminary diagnosis, insurance, and demographic information; estimates insurance coverage and patient financial responsibility; and prepares reimbursement and liability forms. During the first appointment, the representative explains insurance coverage, pre-authorizations, benefits, co-pays, deductibles, and out-of-pocket expenses; discusses payment arrangements and possible assistance programs; and reviews and obtains signatures on applicable forms. The role also obtains insurance authorization or referral approval codes before each treatment, reviews account balances, and ensures co-pay amounts are entered or relayed correctly. The representative processes refund requests and adjustments, may address delinquent payments with patients or payers, and verifies and updates patient demographics and insurance at each visit. The role maintains knowledge of financial aid resources and relationships with providers, follows applicable patient-record confidentiality and privacy laws and guidelines, maintains manuals and documentation, and performs other duties as assigned. The general pay scale is $22.31–$34.32 per hour. The actual hiring rate depends on factors including prior work experience, education, responsibilities, location, and performance.

Requirements

High school diploma or equivalent required.
Minimum three years of pre-services coordinator experience required.
Minimum two years of patient benefits experience required.
Demonstrated knowledge of CPT coding and HCPS coding manuals.
Ability to communicate clearly and use appropriate, correct terminology.
Demonstrated knowledge and appropriate application of insurance coverage, benefits, and terminology.

Nice To Haves

Associate degree in Finance or Business, or four years of revenue cycle experience, preferred.

Responsibilities

Obtain preliminary diagnosis, insurance coverage, and demographic information before a patient’s first appointment.
Estimate insurance coverage and patient financial responsibility, and complete patient cost estimate forms.
Prepare reimbursement and liability forms for patients’ first appointments.
Educate patients about coverage, pre-authorizations, benefits, co-pays, deductibles, and out-of-pocket expenses.
Assess patients’ ability to meet expenses and discuss payment arrangements.
Educate patients about financial assistance programs, identify assistance sources, and help complete forms as appropriate.
Review reimbursement and liability forms with patients and obtain approval signatures.
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 need to meet with the representative.
Ensure patient co-pay amounts are correctly entered into the system or conveyed to the front desk.
Review and process refund requests and adjustments.
May discuss and resolve delinquent payments with patients and/or payers.
Verify and update patient demographics and insurance coverage in the computer system at each visit according to SOPs.
Stay current on financial aid and develop professional relationships and networks with financial aid providers.
Follow confidentiality requirements and applicable state and federal laws and guidelines regarding patient records.
Maintain updated manuals, logs, forms, and documentation.
Perform additional duties as requested or assigned.