Patient Benefits Representative

Overview

The US Oncology Network is seeking a Patient Benefits Representative to join the Texas Oncology team at 6957 W. Plano Parkway Suite 2000A in Plano, Texas. This full-time position operates Monday through Friday, 8:30a - 5:00p. The role is at either level 1 or senior level, depending on relevant experience.

Responsibilities

• Prior to treatment, obtains insurance coverage information and demographics; educates patients on insurance coverage, benefits, co-pays, deductibles, and out-of-pocket expenses.
• Assesses patients' ability to meet expenses and discusses payment arrangements. Educates patients on financial assistance programs and identifies sources of assistance.
• Completes Patient Cost Estimate forms based on diagnosis, estimated insurance coverage, and financial assistance. Ensures appropriate reimbursement and liability forms are completed and forwarded to the billing office.
• Obtains insurance pre-authorization or referral approval codes from the Clinical Reviewer before each treatment. Verifies and updates patient account balances and notifies the front desk if necessary.
• Ensures accurate entry of patient co-pay amounts into the system (or conveys this information) so the front desk can collect payments appropriately.
• Updates patient demographics and insurance coverage in the computer system according to Standard Operating Procedures (SOPs) at each patient visit.
• Stays current on available financial aid options and develops professional relationships with financial aid providers. Networks with these providers to obtain leads for other aid programs.
• Maintains confidentiality, complies with state, federal, and HIPAA laws and guidelines regarding patient records, and keeps updated manuals, logs, forms, and documentation.
• Performs additional duties as requested or assigned.

Qualifications

• Level 1: High school diploma or equivalent required, minimum three (3) years patient pre-services coordinator or equivalent experience required, proficiency with computer systems and Microsoft Office (Word and Excel) required, knowledge of CPT coding and HCPCS coding application, ability to communicate clearly and use appropriate terminology, must complete required e-learning courses within 90 days of occupying position.
• Level Sr: Associate degree in Finance, Business, or four years revenue cycle experience preferred, minimum three (3) years pre-services coordinator experience and two (2) years of patient benefits experience required, ability to demonstrate knowledge and application of insurance coverage benefits and terminology, must complete required e-learning courses within 90 days of occupying position.

Physical Demands

The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic. Work involves in-person interaction with co-workers and management and/or clients. Minimal travel by automobile to office sites may be required.