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Texas Oncology · 10 hours ago

Patient Benefit Representative team lead

Bedford, TX

Full-time

Onsite

Mid Level

3+ years exp

Texas Oncology is part of The US Oncology Network, dedicated to providing high-quality cancer care. The Patient Benefits Representative Lead will educate patients on insurance coverage, assess financial abilities, and support the onboarding of new hires while adhering to compliance standards.

AssociationBiotechnologyHealth CareOncology

Responsibilities

Prior to a patients first appointment, obtains preliminary diagnosis, insurance coverage information and demographics. Based upon diagnosis, estimates insurance coverage, financial obligation, and completes patient cost estimate forms. Prepares and completes appropriate reimbursement and liability forms for patients first appointment

During patients first appointment, educates patient on insurance coverage, pre-authorizations, benefits, co-pays, deductibles, and out-of-pocket expenses. Assess patients 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

Maintains current knowledge on TxO Standard Operating Procedures (SOPs) and best practices, and supports the on the job training and onboading of new PBR staff

Ensure 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)

Maintains updated manuals, logs, forms, and documentation. Performs additional duties requested. Other duties as requested or assigned

Qualification

Patient Benefits experienceCPT coding knowledgeHCPCS coding knowledgeRevenue cycle experienceInsurance coverage knowledgeSound judgmentWork commitmentQuality commitmentVerbal communicationAdaptability