Patient Benefits Representative

US Oncology Inc.; Irving (TX); On-site; USD 60,000 - 80,000; Full time

Job summary

A leading oncology network is seeking a dedicated Patient Benefits Representative to join their vibrant team in Irving, Texas. This full-time role focuses on educating patients about their insurance coverage and financial options, ensuring they receive the best possible support during their treatment journey. You will play a crucial role in navigating the complexities of insurance benefits, assisting patients with financial arrangements, and maintaining accurate records. If you are passionate about making a difference in the lives of cancer patients and thrive in a collaborative environment, this is an exciting opportunity to contribute to a mission-driven organization committed to delivering high-quality care.

Qualifications

• 3+ years as a patient pre-services coordinator or equivalent required.
• Proficiency with computer systems and knowledge of CPT coding needed.

Responsibilities

• Educate patients on insurance coverage, benefits, and financial assistance.
• Obtain insurance pre-authorization codes prior to treatment.

Skills

Insurance Knowledge

Patient Communication

Financial Assessment

CPT Coding Knowledge

Microsoft Office Proficiency

Education

High School Diploma

Associate's Degree in Finance or Business

Tools

Microsoft Word

Microsoft Excel

Job description

Overview

The US Oncology Network is looking for a Patient Benefits Representative to join our team at Texas Oncology. This full-time position will support our Las Colinas clinic at 7200 Highway 161. Typical work schedule is Monday - Friday; 8:30am to 5:00pm.

This position will be a level 1 or Sr depending on relevant candidate experience.

As a part of The US Oncology Network, Texas Oncology delivers high-quality, evidence-based care to patients close to home. Texas Oncology is the largest community oncology provider in the country and has approximately 530 providers in 280+ sites across Texas. Our mission is to use leading-edge technology and research to deliver high-quality, evidence-based cancer care to help our patients achieve “More breakthroughs. More victories.” in their fight against cancer.

What does the Patient Benefits Representative do? (including, but not limited to)

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

Responsibilities

The essential duties and responsibilities (including, but not limited to):

• Prior to a patient receiving treatment, obtains insurance coverage information and demographics; educates patients 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 and provide assistance with completing forms.
• Completes appropriate reimbursement and liability forms for patients’ review and signature. Forwards appropriate information and forms to the billing office.
• Responsible for obtaining insurance pre-authorization or referral approval codes prior to each treatment.
• Reviews patient account balances and notifies the front desk of patients to meet with.
• Ensures that patient co-pay amounts are correctly entered into the system, allowing the front desk to collect appropriately.
• At each patient visit, verifies and updates demographics and insurance coverage in the computer system according to Standard Operating Procedures (SOPs).
• Stays current on available financial aid. Develops professional relationships with financial aid providers.
• Adheres to confidentiality, state, federal, and HIPAA laws and guidelines regarding patient records.
• Maintains updated manuals, logs, forms, and documentation. Performs additional duties as requested.
• Other duties as requested or assigned.

Qualifications

The ideal candidate for the Patient Benefits Representative will have the following background and experience:

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 HCPCS 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 the 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.
• Demonstrates Adaptability: Handles day-to-day work challenges confidently; is willing and able to adjust to multiple demands.
• Uses Sound Judgment: Makes timely, cost-effective and sound decisions.
• 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.

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.

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.