Patient Benefit Representative

US Oncology Inc.; Silver Spring (MD); On-site; USD 31,000 - 47,000; Full time

Job summary

Maryland Oncology Hematology seeks a Pre-Services Coordinator to educate patients about insurance coverage and benefits, estimate costs, and assist with pre-authorizations. The role supports reimbursement workflows in a busy oncology setting.

Responsibilities include preparing cost estimates, obtaining approvals and maintaining accurate patient records while ensuring HIPAA compliance and quality service.

Qualifications

• High school diploma or equivalent required.
• Associates degree in Finance, Business or four years revenue cycle experience preferred.
• Minimum three years pre-services coordinator experience and two years patient benefits experience required.
• Knowledge of CPT coding and HCPCS coding manuals.
• Clear verbal communication and correct terminology.
• Knowledge of insurance coverage benefits and terminology.

Responsibilities

• Obtain diagnosis, insurance information and demographics before the first appointment.
• Educate patients on coverage, pre-authorizations, benefits, co-pays and payment options.
• Obtain pre-authorization or referral codes from Clinical Reviewer.
• Review balances and inform front desk of patients to meet with.
• Ensure patient co-pays are correctly entered in the system.
• Process refunds and adjustments; address delinquent payments as needed.
• Verify demographics and coverage at each visit.
• Maintain confidentiality and HIPAA compliance.
• Maintain manuals, logs, forms and documentation.
• Perform additional duties as requested.

Skills

CPT/HCPCS coding knowledge

Clear verbal communication

Insurance coverage knowledge

Revenue cycle experience

Education

High school diploma or equivalent

Associates degree in Finance/Business

Job description

Overview

Join Our Team at Maryland Oncology Hematology!

We’re looking for passionate and talented professionals to join our team in providing exceptional cancer care. If you’re dedicated to making a difference for patients, physicians, and colleagues, we want to hear from you! With 15+ locations across Maryland and DC, we offer a dynamic and supportive environment where you can grow and thrive.

Explore opportunities with us and apply today!

The general pay scale for this position at MOH is $22.31 - $34.32 per hour. The actual hiring rate is dependent on many factors, including but not limited to prior work experience, education, job/position responsibilities, location, work performance, etc.

SCOPE: Under general supervision, responsible for educating patient on insurance coverage and benefits. Assess patients financial ability; may educate patient 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

ESSENTIAL RESPONSIBILITIES:

• Prior to a patients first appointment, obtains preliminary diagnosis, insurance coverage information and demographics. Based upon diagnosis, estimates insurance coverage, financial obligation, and completes patient cost estimate forms. Prepares and completes appropriate reimbursement and liability forms for patients first appointment.
• During patients first appointment, educates patient on insurance coverage, pre-authorizations, benefits, co-pays, deductibles, and out-of-pocket expenses. Assess 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. Reviews reimbursement and liability forms with patient and obtains approval signatures.
• 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
• Ensure that patient co-pay amount is correctly entered into system (or conveyed), allowing front desk to collect appropriately
• Reviews and processes refund requests and adjustments. May discuss and resolve delinquent payments with patient and/or payers.
• 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 HIPPA laws and guidelines with regards to patient*s records.
• Maintains updated manuals, logs, forms, and documentation. Performs additional duties as requested.
• Other duties as requested or assigned.

Qualifications

MINIMUM QUALIFICATIONS:

High school diploma or equivalent required. 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 of CPT coding and HCPS coding manuals.
• Must verbally communicate clearly and utilize the appropriate and correct terminology.
• 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 a san 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 inn 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 evaluated products, processes, and service against those standards; manages quality; improves efficiencies.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 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.

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.