Patient Benefits Representative Team Lead-Radiation

The US Oncology Network; Plano (TX); On-site; USD 28,000 - 41,000; Full time

Job summary

The US Oncology Network Texas Oncology is seeking a Patient Benefits Representative Lead to support the Radiation Oncology Department in Plano, TX. This full-time role focuses on assessing insurance coverage, guiding patients through benefits, and coordinating pre-authorizations for treatments.

The ideal candidate will have 3+ years in patient benefits, CPT/HCPCS knowledge, and strong communication skills to assist patients with financial options and ensuring accurate cost estimates.

Qualifications

• High school diploma or equivalent required.
• Associates degree in Finance/Business or 6 years revenue cycle experience preferred.
• Minimum 3 years of Patient Benefits experience required.
• Must demonstrate knowledge of CPT coding and HCPCS coding manuals.
• Must verbally communicate clearly and utilize correct terminology.
• Must demonstrate knowledge of insurance coverage benefits and terminology.

Responsibilities

• Before the patient's first appointment, obtains preliminary diagnosis, insurance coverage information and demographics; estimates coverage and completes patient cost estimate forms.
• During first appointment, educates patient on insurance coverage, pre-authorizations, benefits, co-pays, deductibles and out-of-pocket expenses; discusses payment arrangements and potential financial assistance programs.
• Obtains pre-authorization or referral approval codes from Clinical Reviewer prior to treatment.
• Keeps current knowledge of SOPs and supports onboarding of new staff.
• Ensures patient co-pay amounts are correctly entered and conveyed to front desk for collection.
• Reviews refund requests and adjustments; discusses delinquent payments with patients and payers.

Skills

CPT coding

Insurance terminology

Verbal communication

Adaptability

Teamwork

Education

High school diploma or equivalent

Associates degree in Finance/Business

Job description

Overview

The US Oncology Network is looking for a Patient Benefits Representative Lead to join our team at Texas Oncology. This full-time position will support the Radiation Oncology Department at our 3705 W. 15th clinic in Plano, TX. Typical work week is Monday through Friday, 7:30a - 4:00p.

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 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.

Responsibilities

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

• 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.

• Maintains current knowledge on TxO Standard Operating Procedures (SOPs) and best practices, and supports the on the job training and onboading of new PBR staff.

• 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).

• Maintains updated manuals, logs, forms, and documentation. Performs additional duties requested. Other duties as requested or assigned.

Qualifications

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

• High school diploma or equivalent required

• Associates degree in Finance/Business or 6 years of revenue cycle experience preferred

• Minimum 3 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.