Patient Benefits Representative

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.
• 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.
• Maintains updated manuals, logs, forms, and documentation.
• Performs additional duties as requested.

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. Demonstrates 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: 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.