Patient Services Representative Sr

The US Oncology Network is looking for a Patient Services Representative Sr to join our team at Texas Oncology. This full-time position will support the Gyn Onc department at the Central, North, and South Austin locations. This is a full-time position working Monday-Wednesday 8am-5pm and Thursday-Friday 7:30am-4:30pm with no weekends, call, or major holidays.

Notes from hiring manager: Texas Oncology's Gynecologic Oncology department offers an exceptional opportunity to grow your career in women's health. You will join a supportive, team-oriented environment where collaboration, professional development, and work life balance are valued. Our compassionate team is dedicated to delivering high quality, patient-centered care and making a meaningful difference in the lives of those we serve every day. If you are ready to take the next step in your career and contribute to outstanding patient care, we encourage you to apply and become part of our dedicated oncology team.

As a part of The US Oncology Network, Texas Oncology delivers high-quality, evidence-based care to patients close to home. Texas Oncology is the largest community oncology provider in the country and has approximately 530 providers in 280+ sites across Texas, our founders pioneered community-based cancer care because they believed in making the best available cancer care accessible to all communities, allowing people to fight cancer at home with the critical support of family and friends nearby. Our mission is still the same today-at Texas Oncology, we use leading-edge technology and research to deliver high-quality, evidence-based cancer care to help our patients achieve "More breakthroughs. More victories." in their fight against cancer. Today, Texas Oncology treats half of all Texans diagnosed with cancer on an annual basis.

The US Oncology Network is one of the nation's largest networks of community-based oncology physicians dedicated to advancing cancer care in America. The US Oncology Network is supported by McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care.

What does the Patient Services Representative Sr do?

Under direct supervision, performs general business office functions that may include some or all of the following: billing and claim submissions; charge capture and payment posting; insurance verification and eligibility; obtaining pre-authorization; counseling patients and families on insurance and payment issues; and account follow-up and payment resolution. As necessary, assists patients and families with obtaining community resources including, but not limited to, housing, transportation, and financial support. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.

The essential duties and responsibilities (including but not limited to):

• Ensures all insurance, demographic, and eligibility information is obtained from patients and entered into the system accurately and timely. Registers patients in the system as necessary.
• Confirms patient insurance verification and eligibility. Obtains pre-authorization of services and/or referrals. Assesses patient financial requirements and advises patients and families on insurance benefits, co-pays, and financial obligations.
• Assists patients with researching and obtaining community resources including housing, transportation, medications, and financial assistance as needed.
• Plan, implement, coordinate, evaluate and promote the continuity of care consistent with established standards and practices.
• Coordinate tasks associated with case scheduling to include completion of all required pre-surgery/procedure tasks, based on type of case:
  • Coordinate pre-operative appointments with/for the patient.
  • Notify any needed representatives of surgery case (e.g., Vendors, First Assists, etc.).
  • Confirm/verify if a special product needs to be ordered for the case.
  • Coordinate, schedule, and authorize pre-operative clearance testing and any diagnostic imaging, (e.g., CT, MRI, US, X-Ray).
  • Complete & send all required scheduling documentation to surgical facility (include authorization/pending authorization info).
  • Complete and send History and Physical, surgical order, and any required documentation to physician for review/signature.
  • Complete & send surgical facility consent form with patient & physician signature.
  • May manage "Global Period" alerts in EMR and/or Practice Management System for applicable surgeries.
  • Scan any surgery documents into EMR as applicable (e.g. signed surgery orders, consents, cardiac clearance, authorizations).
• Review with patient name of procedure/surgery to be performed.
• Review with patient any embedded protocols, notifications and/or tasks to be completed.
• Discuss with patient any/all preparations including bowel preps.
• Confirm surgery scheduled date with the patient, facility and anesthesia.
• Requests and ensures appropriate authorizations are obtained in a timely/effective manner for all scheduled procedures/surgeries.
  • For insured patients, determines necessary authorization and pre-certification for surgery and other necessary surgical services with the proper Procedure (CPT) and Diagnosis codes (ICD-10}.
  • Reviews, audits, and adheres to medical policy as outlined by payors to ensure accurate authorization and ensure no delay in reimbursement.
  • Serve as a patient advocate and serves as a liaison between the patient, payor, office and facility to answer questions and escalate issues.
  • Maintains working knowledge of surgical authorization requirements to prevent delays and denials.
• Ensure reports (e.g., Pathology, OR, other) are captured in chart.
  • Surgical pathology reports are in chart.
  • All patients have returned to the office as ordered (including stent removals/exchanges).
  • Obtain missing Pathology reports.
  • Schedule any needed appointments not already scheduled, either self or via Physician clinic scheduler as appropriate.
• Release any OR blocks with surgical facilities in accordance with stated policy to avoid penalties associated with OR utilization rates.

The ideal candidate for the Patient Services Representative Sr will have the following background and experience:

• High School Diploma or equivalent required.
• Minimum five years medical business office experience.

Physical Demands:

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 regularly required to sit and use hands to finger, handle, or feel. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 30 pounds. Requires vision and hearing corrected to normal ranges. Requires vision and hearing corrected to normal ranges.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work requires frequent interaction with patients and staff.