Patient Benefit Representative

The US Oncology Network; Washington (District of Columbia); On-site; USD 27,000 - 42,000; Full time

Job summary

Maryland Oncology Hematology is seeking qualified professionals to join our oncology practice. The role focuses on educating patients about insurance coverage, benefits, and cost-sharing while supporting billing and financial assistance processes.

Responsibilities include obtaining pre-authorization, updating patient demographics, and ensuring accurate co-pay entries. A strong understanding of HIPAA and compliance is essential in this patient-facing position.

Qualifications

• Uses Technical and Functional Experience: up-to-date knowledge of the profession and industry; regarded as a subject matter expert.
• Demonstrates Adaptability: handles daily challenges and shifts in priorities; resilient under constraints.
• Uses Sound Judgment: makes timely, cost-effective decisions under uncertainty.
• Shows Work Commitment: maintains high performance standards and pursues ambitious goals.

Responsibilities

• Obtain insurance coverage information and educate patients on benefits, co-pays, deductibles, and out-of-pocket costs; assess ability to pay and discuss payment options.
• Obtain pre-authorization or referral approval codes prior to treatment.
• Review patient account balance and notify front desk to arrange payments.
• Verify and update demographics and insurance coverage in the system per SOPs.
• Stay current on financial aide options; build relationships with aides and providers.

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.

Pay Scale

The general pay scale for this position at MOH is $19.82 $30.4 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

• 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. 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. 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
• 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 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.

Competencies

Qualifications

• 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.