Patient Benefits Representative

The US Oncology Network•Easton, MD

3d•Onsite

About The Position

Under general supervision, the Patient Benefits Representative educates patients about insurance coverage and benefits, assesses their financial ability to meet treatment expenses, and may explain 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. Before treatment, the representative obtains insurance coverage information and patient demographics; explains benefits, co-pays, deductibles, and out-of-pocket expenses; discusses payment arrangements; and may help patients identify financial assistance and complete forms. Based on the diagnosis, estimated insurance coverage, and financial assistance, the representative completes patient cost estimates and reimbursement and liability forms, then forwards relevant information to the billing office. The role also obtains required insurance pre-authorization or referral approval codes, reviews patient account balances, ensures co-pay information is entered or communicated accurately, and verifies and updates patient demographics and insurance coverage at each visit. The representative maintains knowledge of financial assistance options and relationships with assistance providers, protects patient confidentiality, maintains current manuals and records, and performs other assigned duties. The work requires regular presence at the employee site during scheduled business hours and takes place in an oncology/hematology clinic environment, with in-person interaction and possibly minimal travel between office sites.

Requirements

High school diploma or equivalent.
Minimum three years of patient pre-services coordinator experience or equivalent.
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.
Meet the stated physical demands, including sitting or standing, talking or hearing, extensive standing and walking, handling and lifting patients, and occasionally lifting or carrying items weighing up to 40 pounds.
Be present at the employee site during regularly scheduled business hours.

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 as 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 which patients need to meet with staff.
Ensure patient co-pay amounts are entered correctly into the system or communicated so the front desk can collect them appropriately.
Verify and update patient demographics and insurance coverage in the computer system at each visit according to SOPs.
Stay current on financial assistance options and develop professional relationships and networks with assistance 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.