Patient Benefits Representative I

Overview Patient Benefits Representative supporting the Oncology and Radiation Departments at Texas Oncology clinic in San Marcos, Texas. Full‑time position with a typical work week Monday through Friday, 8:30 a.m. – 5:00 p.m. This role is Level 1 or Senior depending on relevant candidate experience. Responsibilities 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 a patient’s financial ability to meet expenses and discuss payment arrangements; educate patients on financial assistance programs and assist with completing forms; based upon diagnosis and estimated coverage, complete a Patient Cost Estimate form. Complete the appropriate reimbursement and liability forms for patient review and signature; forward the 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) so that the front desk can collect appropriately. At each patient visit, verify and update demographics and insurance coverage in the computer system according to SOPs. Stay current on available financial aid, develop professional relationships with providers, and network to obtain leads for other programs. Adhere to confidentiality, state and federal laws, HIPAA guidelines, and the US Oncology Compliance Program. Maintain updated manuals, logs, forms, and documentation; perform additional duties as requested. Other duties as requested or assigned. Qualifications Level 1: High school diploma or equivalent. Minimum three (3) years patient pre‑services coordinator or equivalent experience. Proficiency with computer systems and Microsoft Office (Word and Excel). Knowledge of CPT and HCPCS coding application. Clear verbal communication skills and appropriate terminology usage. Complete required e‑learning courses within 90 days of starting the position. Level Sr (in addition to Level 1 requirements): Associate’s degree in Finance, Business or four years of revenue cycle experience preferred. Minimum three (3) years pre‑services coordinator experience and two (2) years of patient benefits experience. Demonstrated knowledge and application of insurance coverage benefits and terminology. Competencies Uses technical and functional knowledge to assist patients, staying updated and consulting experts as needed. Demonstrates adaptability, handling day‑to‑day challenges confidently, adjusting to varying demands, priorities, and rapid change. Uses sound judgment, making timely, cost‑effective decisions under uncertainty. Shows work commitment, setting high standards and pursuing aggressive goals efficiently. Commits to quality, emphasizing delivery of high‑quality products and services, defining and evaluating standards, and improving efficiency. Physical Demands Reasonable accommodations may be made. Requires presence at the employee site during scheduled hours; often involves sitting or standing, talking or hearing. Requires full range of motion including handling and lifting patients, manual and finger dexterity, eye‑hand coordination, prolonged standing and walking. Occasionally lifts items up to 40 lbs. Requires corrected vision and hearing within normal range. Work Environment Typical oncology clinic environment with exposure to communicable diseases, toxic substances, ionizing radiation, and medical preparations. Involves in‑person interaction with co‑workers, management and clients; occasional minimum travel by automobile to other office sites. #J-18808-Ljbffr The US Oncology Network