Patient Benefits Representative

The US Oncology Network•Chicago, IL

8d•Onsite

About The Position

Under general supervision, this role is responsible for educating patients on insurance coverage and benefits. The representative will assess patients’ financial ability and may educate them on assistance programs. This position involves updating and maintaining existing patient new insurance eligibility, coverage, and benefits in the system. The role also requires supporting and adhering to the US Oncology Compliance Program, including the Code of Ethics and Business Standards, and US Oncology's Shared Values.

Requirements

High school diploma or equivalent required.
Minimum three (3) years patient pre-services coordinator or equivalent required.
Proficiency with computer systems and Microsoft Office (Word and Excel) required.
Demonstrate knowledge of CPT coding and HCPS coding application.
Must be able to verbally communicate clearly and utilize the appropriate and correct terminology.
Must successfully complete required e-learning courses within 90 days of occupying position.
Possesses up to date knowledge of the profession and industry; is regarded as an expert in the technical/functional area; accesses and uses other expert resources when appropriate.
Handles Day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities, ambiguity and rapid change; shows resilience in the face of constraints, frustrations, or adversity; demonstrates flexibility.
Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty.
Sets high standards of performance; pursues aggressive goals and works efficiently to achieve them.
Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluated products, processes, and service against those standards; manages quality; improves efficiency.

Responsibilities

Verify active insurance coverage, benefits, and pre-authorization requirements prior to patient services.
Coordinate, track, and secure necessary referrals and primary care authorizations in a timely manner.
Meet with patients to discuss their financial responsibilities, review outstanding insurance balances, and present flexible payment options or financial assistance programs.
Identify underinsured or financially constrained patients and proactively research, apply for, and secure charitable grants, disease-specific foundations, and manufacturer copay assistance cards to lower their out-of-pocket costs.
Obtain insurance coverage information and demographics prior to a patient receiving treatment; educate patient on insurance coverage, benefits, co-pays, deductibles, and out-of-pocket expenses.
Assess patients’ ability to meet expenses and discuss payment arrangements.
Educate patients on financial assistance programs as well as identify sources and provide assistance with completing forms.
Complete Patient Cost Estimate form based upon diagnosis, estimated insurance coverage, and financial assistance.
Complete appropriate reimbursement and liability forms for patients review and signature.
Forward appropriate information and forms to the billing office.
Obtain, from the Clinical Reviewer, insurance pre-authorization or referral approval codes prior to each treatment.
Review patient account balance and notify the front desk of patients to meet with providers.
Ensure that patient co-pay amount is correctly entered into the system (or conveyed), allowing the front desk to collect appropriately.
Verify and update demographics and insurance coverage in computer systems according to Standard Operating Procedures (SOPs) at each patient visit.
Stay current on available financial aid.
Develop professional relationships with financial aid providers.
Network with financial aid providers to obtain leads to other aid programs.
Adhere to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patients' records.
Maintain updated manuals, logs, forms, and documentation.
Perform other duties as requested or assigned.