Patient Benefits Representative Sr

Overview

Join Our Team at Maryland Oncology Hematology! We’re looking for passionate and talented professionals to join our team in providing exceptional cancer care. If you’re dedicated to making a difference for patients, physicians, and colleagues, we want to hear from you! With 15+ locations across Maryland and DC, we offer a dynamic and supportive environment where you can grow and thrive.

Explore opportunities with us and apply today!

The general pay scale for this position at MOH is $22.31 - $34.32 per hour.
The actual hiring rate is dependent on many factors, including but not limited to prior work experience, education, job/position responsibilities, location, work performance, etc.

With minimal supervision, responsible for educating patient on insurance coverage and benefits. Assess patients financial ability; may educate patient 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, to include the Code of Ethics and Business Standards, and US Oncology's Shared Values.

• Prior to a patient's first appointment, obtains preliminary diagnosis, insurance coverage information and demographics. Based on diagnosis, estimates insurance coverage, financial obligation, and completes patient cost estimate forms. Prepares and completes appropriate reimbursement and liability forms for patient's first appointment.
• During patient's first appointment, educates patient on insurance coverage, pre-authorizations, benefits, co‑pays, deductibles and out‑of‑pocket expenses. Assesses patient's 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.
• 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.
• 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).
• Stays current on available financial aid. 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.

Minimum Qualifications:

• High school diploma or equivalent required. Associates 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 of CPT coding and HPCI 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.

• Uses Technical and Functional
  
  Experience:
  
  Possesses up to date knowledge of the profession and industry; is regarded a senior 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…