Patient Benefits Representative - Full-Time - 7447 W Talbott Ave, Chicago, IL
SCOPE:
Under general supervision, 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 the system. Supports and adheres to the US Oncology Compliance Program, including the Code of Ethics and Business Standards, and US Oncology's Shared Values.
Responsibilities:
- Prior to a patient receiving treatment, obtains insurance coverage information and demographics; educates patients 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 as well as 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 patients' review and signature.
- Forwards appropriate information and forms to the billing office.
- 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 the system (or conveyed), allowing front desk to collect appropriately.
- At each patient visit, verifies and updates demographics and insurance coverage in the 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 regarding patients' records.
- Maintains updated manuals, logs, forms, and documentation. Performs additional duties as requested.
Qualifications:
- 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.
- Possesses up-to-date knowledge of the profession and industry; is regarded as an expert in the technical/functional area; accesses and uses other expert resources when appropriate.
- 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.
- Makes timely, cost-effective, and sound decisions; makes decisions under conditions of uncertainty.
- Sets high standards of performance; pursues aggressive goals and works efficiently to achieve them.
- Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluates products, processes, and service against those standards; manages quality; improves efficiencies.
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