Patient Benefits Representative

The US Oncology Network•Mount Pleasant, 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 medical expenses, and explain available assistance programs. The role updates and maintains patient insurance eligibility, coverage, benefits, and demographics in the computer system, and supports The US Oncology Network Compliance Program, Code of Ethics and Business Standards, and Shared Values. This full-time position supports the Medical Oncology Department at Texas Oncology’s clinic at 1612 Shadywood Lane in Mt. Pleasant, Texas. The typical schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. The position may be hired at Level 1 or Senior, depending on relevant experience.

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 Word and Excel.
Knowledge of CPT coding and HCPS coding application.
Ability to communicate clearly verbally and use appropriate terminology.
For Senior level, at least three years of pre-services coordinator experience and two years of patient benefits experience.
For Senior level, ability to demonstrate knowledge and appropriate application of insurance coverage, benefits, and terminology.

Nice To Haves

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

Responsibilities

Before treatment, obtain patient insurance coverage information and demographics, and explain 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 potential sources of assistance, 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 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 need to meet with staff.
Ensure patient co-pay amounts are correctly entered into or conveyed for the system so the front desk can collect the appropriate amount.
At each patient visit, verify and update demographics and insurance coverage in the computer system according to standard operating procedures.
Stay current on financial assistance resources and develop professional relationships and referral networks with financial assistance providers.
Protect patient records and comply with confidentiality requirements and applicable state and federal laws and guidelines, including HIPAA.
Maintain updated manuals, logs, forms, and documentation.
Complete other duties as requested or assigned.
Complete required e-learning courses within 90 days of occupying the position.