Patient Benefit Representative

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 the Medical Oncology Department at our 901 W. 38th Street clinic in Austin, Texas. Typical work week is Monday through Friday, 8:00a - 4:30p. This position will be a level 1 or Sr depending on relevant candidate experience. 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. They assess patients' financial ability; may educate patients on assistance programs. They update and maintain patients' new insurance eligibility, coverage, and benefits in the system. They support and adhere 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, obtain insurance coverage information and demographics; educate the patient on insurance coverage, benefits, co‑pays, deductibles, and out‑of‑pocket expenses. Assess patients' ability to meet expenses and discuss payment arrangements. Educate patients on financial assistance programs, identify sources, and assist with completing forms. Based upon diagnosis, estimated insurance coverage, and financial assistance, complete the Patient Cost Estimate form. Complete appropriate reimbursement and liability forms for the patient’s review and signature; forward the appropriate information and forms to the billing office. Obtain, from the Clinical Reviewer, insurance pre‑authorization or referral approval codes prior to each treatment. Review patient account balance and notify the front desk of patients to meet with. Ensure that the patient co‑pay amount is correctly entered into the system (or conveyed), allowing the front desk to collect appropriately. At each patient visit, verify and update demographics and insurance coverage in the computer system according to Standard Operating Procedures (SOPs). Stay current on available financial aid; develop professional relationships with financial aid providers; network with these providers to obtain leads on other aid programs. Adhere to confidentiality, state, federal, and HIPAA laws and guidelines regarding patient records. Maintain updated manuals, logs, forms, and documentation; perform 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 of patient pre‑services coordinator or equivalent experience required. Proficiency with computer systems and Microsoft Office (Word and Excel) required. Demonstrate knowledge of CPT coding and HCPS coding application. Must be able to verbally communicate clearly and utilize appropriate terminology. Must successfully complete required e‑learning courses within 90 days of occupying the position. Level Sr (in addition to level 1 requirements) Associate degree in Finance, Business, or four years of revenue cycle experience preferred. Minimum three (3) years of pre‑services coordinator experience and two (2) years of patient benefits experience required. Must 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; accesses and uses 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 services 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, management, and/or clients. Work may require minimal travel by automobile to office sites. #J-18808-Ljbffr