Patient Benefits Representative

The US Oncology Network•Dallas, TX

2d•Onsite

About The Position

The Patient Benefits Representative works under general supervision to educate patients about insurance coverage and benefits, assess their ability to meet healthcare expenses, and provide information about financial 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. This full-time role supports the Revenue Cycle Departments at Texas Oncology’s 8196 Walnut Hill #100 clinic in Dallas, Texas, and supports two oncology locations. The position may be filled at Level 1 or Senior level, depending on relevant experience. The typical workweek is Monday through Friday, with eight hours scheduled between 7:30 a.m. and 5:00 p.m. The work is performed in an oncology/hematology clinic environment and involves in-person interaction with coworkers, management, and clients. The role requires presence at the employee site during regularly scheduled business hours and may involve minimal automobile travel to office sites.

Requirements

High school diploma or equivalent.
At least three years of patient pre-services coordinator or equivalent experience for Level 1.
Proficiency with computer systems and Microsoft Office, including Word and Excel.
Knowledge of CPT coding and HCPS coding application.
Ability to communicate clearly verbally and use appropriate, correct terminology.
Successfully complete required e-learning courses within 90 days of occupying the position.
For Senior level, meet Level 1 requirements and have at least three years of pre-services coordinator experience and two years of patient benefits experience.
For Senior level, demonstrate knowledge and appropriate application of insurance coverage, benefits, and terminology.
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, handling and lifting patients, extensive standing and walking, and occasionally lifting and carrying items weighing up to 40 pounds.

Nice To Haves

For Senior level, an associate degree in Finance or Business, or four years of revenue cycle experience, is preferred.

Responsibilities

Before patients receive treatment, obtain insurance coverage information and demographics, and educate patients about coverage, 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 patients complete forms.
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 relevant 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 which patients should meet with the representative.
Ensure patient co-pay amounts are correctly entered into or conveyed for the system so the front desk can collect them appropriately.
At each patient visit, verify and update demographics and insurance coverage in the computer system according to Standard Operating Procedures.
Stay current on available financial aid and develop professional relationships with financial aid providers to identify other assistance programs.
Protect confidentiality and comply with state and federal laws and guidelines concerning patient records, including HIPAA requirements.
Maintain updated manuals, logs, forms, and documentation.
Complete other duties as requested or assigned.