Patients Benefits Representative

The US Oncology Network•Brandywine, MD

6d•Onsite

About The Position

Under general supervision, the Patients Benefits Representative educates patients about insurance coverage and benefits and assesses their financial ability to meet treatment expenses. The representative updates and maintains patient insurance eligibility, coverage, benefits, and demographic information in the system, and may explain available financial assistance programs. The role supports and adheres to the US Oncology Compliance Program, including its Code of Ethics and Business Standards and Shared Values. Before treatment, the representative obtains insurance and demographic information; explains coverage, benefits, co-pays, deductibles, and out-of-pocket expenses; discusses payment arrangements; and may help patients identify and apply for financial assistance. Based on diagnosis, estimated coverage, and assistance, the representative completes patient cost estimates and reimbursement and liability forms, then forwards appropriate information to the billing office. The role also obtains pre-authorization or referral approval codes, monitors patient account balances and co-pay information, and verifies and updates patient records at each visit. The position requires a high school diploma or equivalent and at least three years of patient pre-services coordinator experience or equivalent. The representative must be proficient with computer systems and Microsoft Office, demonstrate knowledge of CPT and HCPS coding application, communicate clearly using appropriate terminology, and complete required e-learning courses within 90 days of starting. Work is performed at the employee site during regularly scheduled business hours in an oncology/hematology clinic environment, with in-person interaction and potentially minimal automobile travel between office sites. The stated pay scale is $19.82–$30.40 per hour; the actual hiring rate depends on factors including experience, education, responsibilities, location, and performance.

Requirements

High school diploma or equivalent.
At least 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 and correct terminology.
Ability to complete required e-learning courses within 90 days of occupying the position.
Ability to meet the stated physical demands, including sitting or standing, talking or hearing, extensive standing and walking, and occasionally lifting and carrying items up to 40 pounds.
Ability to work at the employee site during regularly scheduled business hours.
Ability to comply with confidentiality requirements and state, federal, and HIPAA laws and guidelines.

Responsibilities

Obtain patient insurance coverage information and 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.
Educate patients about financial assistance programs, identify assistance sources, and help complete forms when applicable.
Complete patient cost estimate forms based on diagnosis, estimated insurance coverage, and financial assistance.
Complete appropriate reimbursement and liability forms for patient review and signature, and forward 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 a representative.
Ensure patient co-pay amounts are entered into or conveyed to the system 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 available financial aid, develop professional relationships with financial aid providers, and network to identify additional assistance programs.
Protect patient records and comply with confidentiality requirements and applicable state, federal, and HIPAA laws and guidelines.
Maintain updated manuals, logs, forms, and documentation.
Perform additional duties as requested or assigned.
Complete required e-learning courses within 90 days of occupying the position.