Patient Benefits Representative Lead

About the position

The Patient Benefits Representative Lead at Texas Oncology plays a crucial role in supporting patients by educating them on insurance coverage and benefits, assessing their financial abilities, and guiding them through assistance programs. This full-time position is integral to ensuring that patients receive the necessary information and support regarding their financial obligations and insurance processes, ultimately contributing to the high-quality, evidence-based cancer care provided by Texas Oncology.

Responsibilities

• Obtain preliminary diagnosis, insurance coverage information, and demographics prior to a patient's first appointment.
• Estimate insurance coverage and financial obligations based on diagnosis and complete patient cost estimate forms.
• Prepare and complete appropriate reimbursement and liability forms for the patient's first appointment.
• Educate patients on insurance coverage, pre-authorizations, benefits, co-pays, deductibles, and out-of-pocket expenses during their first appointment.
• Assess patients' ability to meet expenses and discuss payment arrangements.
• Educate patients on financial assistance programs and assist with completing forms.
• Review reimbursement and liability forms with patients and obtain approval signatures.
• Obtain insurance pre-authorization or referral approval codes from Clinical Reviewer prior to each treatment.
• Maintain current knowledge on Texas Oncology Standard Operating Procedures (SOPs) and best practices, supporting the onboarding of new Patient Benefits Representatives (PBR).
• Ensure correct entry of patient co-pay amounts into the system for front desk collection.
• Review and process refund requests and adjustments.
• Discuss and resolve delinquent payments with patients and/or payers.
• Verify and update demographics and insurance coverage in the computer system at each patient visit according to SOPs.
• Maintain updated manuals, logs, forms, and documentation.

Requirements

• High school diploma or equivalent required.
• Associates degree in Finance/Business or 6 years of revenue cycle experience preferred.
• Minimum 3 years of Patient Benefits experience required.
• Knowledge of CPT coding and HCPS coding manuals is essential.
• Ability to communicate clearly and utilize appropriate terminology.
• Demonstrated knowledge and application of insurance coverage benefits and terminology.

Nice-to-haves

• Experience in a healthcare setting is preferred.
• Familiarity with oncology-specific insurance processes.

Benefits

• Health insurance coverage
• 401k retirement savings plan
• Paid time off
• Professional development opportunities