Patient Benefits Representative

Overview

Patient Benefits Representative position in Revenue Cycle Department at 1000 Coulter Drive clinic in Amarillo, Texas. Full-time, Monday through Friday, 8:00 a.m. – 5:00 p.m.

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 new insurance eligibility, coverage, and benefits in system. Supports and adheres to the US Oncology Compliance Program, Code of Ethics and Business Standards, and Shared Values.

• 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.
• Assess patients' ability to meet expenses and discuss payment arrangements. May educate patients on financial assistance programs and 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.
• Obtain, from Clinical Reviewer, insurance pre‑authorization or referral approval codes prior to each treatment.
• Review patient account balance and notify front desk of patients to meet with.
• Ensure that patient co‑pay amount is correctly entered into system (or conveyed), allowing front desk to collect appropriately.
• At each patient visit, verify and update demographics and insurance coverage in computer system according to Standard Operating Procedures (SOPs).
• Stay current on available financial aid. Develop professional relationships with financial aid providers. Network with financial aid providers to obtain leads to 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.

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 use appropriate terminology.
• Must 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 demonstrate knowledge and appropriate application of insurance coverage benefits and terminology.

• Uses Technical and Functional
  
  Experience:
  
  Possesses up‑to‑date knowledge of the profession and industry; regarded as an expert in the technical/functional area; accesses and uses other expert resources when appropriate.
• Demonstrates Adaptability:
  Handles day‑to‑day work challenges confidently; 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.

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.…