Patient Benefits Representative Sr

The US Oncology Network•Austin, TX

2d•Onsite

About The Position

The Patient Benefits Representative works under general supervision to educate patients about insurance coverage and benefits, assess their financial ability to meet expenses, and explain available assistance programs. The role maintains patient insurance eligibility, coverage, and benefits information in the system and supports the US Oncology Compliance Program, Code of Ethics and Business Standards, and Shared Values. This full-time position supports the Medical Oncology Department at Texas Oncology’s 6204 Balcones clinic in Austin, Texas. The typical schedule is Monday through Friday, 7:30 a.m. to 4:00 p.m. The position may be filled at Level 1 or Senior, depending on relevant candidate experience.

Requirements

High school diploma or equivalent required for Level 1.
At least three years of patient pre-services coordinator or equivalent experience required 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.
For the Senior level, at least three years of pre-services coordinator experience and two years of patient benefits experience are required.
For the Senior level, demonstrate knowledge and appropriate application of insurance coverage, benefits, and terminology.
Ability to meet the physical demands of the role, including sitting or standing, talking and hearing, extensive standing and walking, full range of body motion, handling and lifting patients, and occasional lifting or carrying of items weighing up to 40 pounds.
Corrected vision and hearing within the normal range.

Nice To Haves

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

Responsibilities

Before treatment, obtain insurance coverage information and patient demographics; explain insurance coverage, benefits, copays, deductibles, and out-of-pocket expenses.
Assess patients’ ability to meet expenses and discuss payment arrangements. Explain financial assistance programs when appropriate, identify funding sources, and assist with 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 when patients should meet with staff.
Ensure patient copay amounts are correctly entered into the system or conveyed 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 assistance, develop professional relationships with assistance providers, and network to identify other assistance programs.
Protect patient records and comply with confidentiality requirements and applicable state and federal laws and guidelines.
Maintain current manuals, logs, forms, and documentation.
Complete required e-learning courses within 90 days of occupying the position.
Perform other duties as requested or assigned.