Patient Benefits Representative Sr

The US Oncology Network•Shenandoah, TX

5d•Onsite

About The Position

The Patient Benefits Representative, under general supervision, educates patients about insurance coverage and benefits, assesses their financial ability to meet expenses, and may explain available assistance programs. The role updates and maintains patient insurance eligibility, coverage, and benefits information in the system. It also supports and adheres to the US Oncology Compliance Program, including its Code of Ethics and Business Standards and Shared Values. This full-time position supports the Oncology Department at Texas Oncology’s clinic at 9180 Pinecroft #600 in The Woodlands, Texas. The typical workweek is Monday through Friday, 8:00 a.m. to 4:30 p.m. The position may be filled at Level 1 or Senior level depending on the candidate’s relevant experience. Texas Oncology is part of The US Oncology Network, a community-based oncology care network supported by McKesson Corporation. The role is performed in an oncology/hematology clinic environment, with in-person interaction and possible minimal travel by automobile to office sites.

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, required.
Knowledge of CPT coding and HCPS coding application required.
Ability to communicate clearly verbally and use appropriate terminology.
Successful completion of required e-learning courses within 90 days of occupying the position.
For Senior level, at least three years of pre-services coordinator experience and two years of patient benefits experience are required.
For Senior level, demonstrated knowledge and appropriate application of insurance coverage, benefits, and terminology are required.
Ability to handle shifting priorities and changing demands, use sound judgment, maintain high performance standards, and deliver quality service.
Ability to be present at the employee site during regularly scheduled business hours.
Ability to sit or stand, talk and hear, handle and lift patients, use manual and finger dexterity and eye-hand coordination, and stand and walk for extensive periods.
Ability to occasionally lift and carry items weighing up to 40 pounds; corrected vision and hearing within the normal range are required.

Nice To Haves

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

Responsibilities

Before treatment, obtain patients’ 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.
Explain financial assistance programs when appropriate, identify potential sources of assistance, and help patients complete forms.
Complete Patient Cost Estimate forms using diagnosis, estimated insurance coverage, and financial assistance information.
Complete reimbursement and liability forms for patient review and signature, and forward the 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 should meet with a representative.
Ensure patient co-pay amounts are correctly entered into the system or conveyed to the front desk for collection.
At each patient visit, verify and update patient 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.
Follow confidentiality requirements and applicable state and federal laws and guidelines for patient records.
Maintain current manuals, logs, forms, and documentation.
Perform additional duties as requested or assigned.