Patient Benefits Representative - Full-Time - 7447 W Talbott Ave, Chicago, IL
SCOPE:
Under general 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.
Responsibilities:
- 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.
- 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. Based upon diagnosis, estimated insurance coverage, and financial assistance, 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.
- Responsible for obtaining, from Clinical Reviewer, insurance pre-authorization or referral approval codes prior to each treatment.
- Review patient account balance and notify front desk of patients to meet with.
- Ensure 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 aide. Develops professional relationships with financial aide providers. Networks with financial aide providers to obtain leads to other aide programs.
- Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to 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 position.
- Uses Technical and Functional Experience: 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.
- 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 Work Commitment: Sets high standards of performance; pursues aggressive goals and works efficiently to achieve them.
- Commits to Quality: 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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