Patient Benefits Representative

Overview

Patient Benefits Representative
Full-Time
Monday-Friday
Hourly Rate: $18-$22
Benefits Include: 401k, HSA, Medical, Dental, Vision, Perks Program (Vitality)

SCOPE

Under general supervision, responsible for educating patients on insurance coverage and benefits. Assess patients’ financial ability; may educate patients on assistance programs. Updates and maintains existing patient new 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

• Insurance Verification: Verify active insurance coverage, benefits, and pre-authorization requirements prior to patient services.
• Referral Management: Coordinate, track, and secure necessary referrals and primary care authorizations in a timely manner.
• Financing Consults: Meet with patients to discuss their financial responsibilities, review outstanding insurance balances, and present flexible payment options or financial assistance programs.
• Identify underinsured or financially constrained patients and proactively research, apply for, and secure charitable grants, disease-specific foundations, and manufacturer copay assistance cards to lower their out-of-pocket costs.
• 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.
• Responsible for obtaining, from Clinical Reviewer, insurance pre-authorization or referral approval codes prior to each treatment.
• Review patient account balance and notify front desk of patients to meet with providers.
• Absolutely ensure 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 systems according to Standard Operating Procedures (SOPs).
• Stay current on available financial aid. Develop professional relationships with financial aid providers. Networks with financial aid providers to obtain leads to other aid programs.
• Maintains updated manuals, logs, forms, and documentation.
• Other duties as requested or assigned.

Qualifications

• 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.
• Successfully complete required e-learning courses within 90 days of occupying position.

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.

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.

Commitments 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 efficiency.