Patient Benefits Representative

Patient Benefits Representative at Texas Oncology

This full‑time position will support the Revenue Cycle Department at our 1901 S. 2nd Street clinic in McAllen, Texas. Typical work week is Monday through Friday, any eight hours between 7:30 a.m. – 5:00 p.m.

Our clinic offers a mission‑driven environment where patient‑centered care, clinical excellence, and operational integrity are genuinely valued. Team members benefit from collaborative leadership, clear expectations, and the opportunity to make a measurable impact on patient outcomes and clinic performance. We invest in our people through professional development, process improvement initiatives, and a culture that emphasizes accountability, respect, and continuous improvement. This is an organization for professionals who want meaningful work, growth opportunities, and leadership that is engaged, supportive, and results‑oriented.

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, update and maintain patient insurance eligibility, coverage, and benefits in the system, and support compliance with the US Oncology Compliance Program.

• 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.
• Assesses patients’ ability to meet expenses and discusses payment arrangements; may educate patients on financial assistance programs and assist with completing forms; 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.
• Obtains, 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.
• 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 aide programs.
• Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regard to patient’s records.
• Maintains updated manuals, logs, forms, and documentation; performs additional duties as requested.
• Other duties as requested or assigned.

• 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 utilize the appropriate and correct terminology.
• Must successfully complete required e‑learning courses within 90 days of occupying the position.

• 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 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 subject‑matter 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;…