Patient Benefits Representative

About the Role

This full-time position will support the Medical/Surgical/Radiation Oncology Department at our 1350 First Colony Blvd clinic in Sugarland, Texas. Typical work week is Monday through Friday, 8:30a - 5:00p. This position will be a level 1 or Sr depending on relevant candidate experience.

Texas Oncology - Sugarland offers the opportunity to work in a dynamic, high-volume oncology clinic where no two days are the same. You'll be part of a supportive team dedicated to helping patients navigate their financial journey so they can focus on what matters most—their care. Our leadership team is committed to creating an environment where employees feel valued, supported, and empowered through open communication, collaboration, and professional development.

What Does the Patient Benefits Representative Do?

The Patient Benefits Representative, under general supervision, is responsible for educating patients on insurance coverage and benefits. Assesses patients' financial ability; may educate patients on assistance programs. Updates and maintains existing patient insurance eligibility, coverage, and benefits in system. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards, and US Oncology's Shared Values.

Responsibilities

• Prior to a patient receiving treatment, obtains insurance coverage information and demographics; educates patient on insurance coverage, benefits, co-pays, deductibles, and out-of-pocket expenses
• Assesses patients' ability to meet expenses and discusses payment arrangements
• May educate patients on financial assistance programs as well as identify sources and provide assistance with completing forms
• Based upon diagnosis, estimated insurance coverage, and financial assistance, completes Patient Cost Estimate form
• Completes appropriate reimbursement and liability forms for patient's review and signature
• Forwards appropriate information and forms to billing office
• Obtains, from Clinical Reviewer, insurance pre-authorization or referral approval codes prior to each treatment
• Reviews patient account balance and notifies front desk of patients to meet with
• Ensures that patient co-pay amount is correctly entered into system (or conveyed), allowing front desk to collect appropriately
• At each patient visit, verifies and updates demographics and insurance coverage in computer system according to Standard Operating Procedures (SOPs)
• Stays current on available financial aide; develops professional relationships with financial aide providers; networks with financial aide providers to obtain leads to other aide programs
• Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient records
• Maintains 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 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

Level Sr (in addition to Level 1 requirements):

• Associates 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
• Must be able to demonstrate knowledge and appropriate application of insurance coverage benefits and terminology

Competencies

• Uses Technical and Functional Experience: 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
• Demonstrates Adaptability: 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
• Uses Sound Judgment: Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty
• Shows Work Commitment: Sets high standards of performance; pursues aggressive goals and works efficiently to achieve them
• Commits to Quality: Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluates products, processes, and service against those standards; manages quality; improves efficiencies

Physical Demands

While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Work Environment

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