Blue Ridge Cancer Care has an exciting opportunity for a FT Patient Benefits Representative Lead. The lead position will assist in overseeing multiple sites.
Blue Ridge Cancer Care is an affiliate of The US Oncology Network that extends an extremely competitive offering of benefits to employees, including Medical Health Care, Dental Care, Vision Plan, 401k, Life Insurance, Short-Term Disability, Long-Term Disability, Wellness and Perks Program.
Come join our growing organization and enjoy knowing that you work for an organization dedicated to making the lives of others better.
Assists the Revenue Cycle Supervisor in overseeing daily revenue cycle operations. Provides leadership and support to Patient Benefit Representatives. May orient, train, and assign the work of lower level employees. Assists the Revenue Cycle Supervisor in supervising and coordinating activities related to PBR functions. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Assists in supervision of Patient Benefit Representatives. Provides leadership and guidance to the Revenue Cycle department.
Coordinates daily work assignments for Patient Benefits Representatives.
Manages payroll functions (time approvals, time off etc.)
Orients and trains new Patient Benefit Representatives and provides input into performance appraisals.
Assists in monitoring the production standards for the department. Assists in monitoring and resolving department problems with appropriate administrators.
Prior to a patient's 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.
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
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).
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 HIPPA laws and guidelines with regards 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. Associates 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 of CPT coding and HCPS coding manuals. Must verbally communicate clearly and utilize the appropriate and correct terminology. 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 san 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 evaluated products, processes, and service against those standards; manages quality; improves efficiencies.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.
The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.
GL Coding (BU & Site): 56888 - 8880
The US Oncology Network is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
Internal Number: MCKEA00878137
About US Oncology Network
The US Oncology Network believes local cancer care is better care. We empower the delivery of advanced integrated cancer care through our network of independent physicians who share expertise and resources to provide quality, value-based care close to home.
Our clinical and business support capabilities, expertise and industry-leading technologies keep local practices at the forefront of high quality, efficient care delivery while enabling practice success, quality of life and financial security for physicians.
- 25 years of oncology practice management expertise
- Leader in value-based cancer care with over 900 physicians participating in the Center for Medicaid and Medicare
- Innovation Oncology Care Model – one fourth of the entire population of physicians nationwide
- Over 1,400 affiliated physicians
- More than 450 cancer treatment center locations across the United States
- Over 995,000 patients treated annually