Patient Benefits Representative

The US Oncology Network; Plano (TX); On-site; USD 45,000 - 60,000; Full time

Job summary

A leading community oncology provider in Texas is seeking a Patient Benefits Representative to support their Radiation and Medical Oncology Departments. In this full-time role, the representative will educate patients on insurance coverage and benefits, assess financial capabilities, and ensure smooth reimbursement processes. Essential qualifications include a high school diploma, proficiency with computer systems, and at least three years of relevant experience. The ideal candidate will thrive in a fast-paced environment focused on providing high-quality cancer care.

Qualifications

• Minimum three years as a patient pre-services coordinator or equivalent required.
• Knowledge of insurance coverage benefits and terminology.
• Proficiency in CPT and HCPCS coding application.

Responsibilities

• Educate patients on insurance coverage, benefits, and out-of-pocket expenses.
• Assess patients’ ability to meet expenses and discuss payment arrangements.
• Obtain necessary insurance pre-authorizations prior to treatment.

Skills

Proficiency with computer systems and Microsoft Office (Word and Excel)

Verbal communication

Knowledge of CPT coding and HCPCS coding

Education

High school diploma or equivalent

Associate’s degree in Finance or Business (preferred)

Job description

Overview

US Oncology Network is looking for a Patient Benefits Representative to join our team at Texas Oncology. This full‑time position will support the Radiation and Medical Oncology Departments at our 4708 Alliance #150 clinic in Plano, Texas. Typical work week is Monday through Friday, 8:30 a.m. – 5:00 p.m. This position will be a level 1 or Sr depending on relevant candidate experience.

As a part of 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 founders pioneered community‑based cancer care because they believed in making the best available cancer care accessible to all communities, allowing people to fight cancer at home with the critical support of family and friends nearby. Our mission is still the same today—at Texas Oncology, we 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. Today, Texas Oncology treats half of all Texans diagnosed with cancer on an annual basis.

The US Oncology Network is one of the nation’s largest networks of community‑based oncology physicians dedicated to advancing cancer care in America. It is supported by McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care.

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, assessing their financial ability, and may educate them on assistance programs. Updates and maintains existing patient new 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 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. 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.
• 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 aid providers. Networks with financial aid providers to obtain leads to other aid programs.
• Adheres to confidentiality, state, federal, and HIPAA 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

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 position.

Level Sr (in addition to Level 1 requirements)

• Associate’s 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 a san (sic) 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 in 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 evaluates 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.