Financial Counselor

Job Summary:

This job exists to ensure that all patients' membership status and alternative payor information is accurately identified and documented. Under indirect supervision, provides financial counsel to patients in a personal interview regarding payor sources and/or health plan benefits.

It will accomplish the following revenue enhancing and member service functions:

• Increase revenue through accurate and timely identification of membership status and alternative payors.
• Counsel patients on payment alternatives.
• Resolve any member or patient disputes regarding eligibility for service.

Essential Responsibilities:

- Confidentially probes patients who have been referred by staff such as inpatients, outpatient registration, department administrators, physicians, nursing, utilization management, and social workers about the nature of their problems as they may concern the ability to have services covered by an alternate payor (Non-member, Coordination of Benefits, Third Party Liability, Workers Compensation) or issues dealing with membership.

- If the patient is determined to be ineligible, uses independent judgment to identify an alternate payor or identify the patient as medical indigent.

- Uses knowledge of Workers Compensation, Commercial Insurance Plans, Third Party liability, outside agencies, and governmental regulations for government programs; patient interview and observation; analysis of financial data; and physicians' notes in order to accurately identify an alternate payor.

- Skillfully probes patients about their financial status, counsels, and makes arrangements for direct payment, status as an indigent, potential enrollment in a government-sponsored program, or direct billing to the patient.

- If the patient is determined to be indigent and not able to qualify for any governmental program, completes a KP medical Financial Assistance application. Based on the analysis of the patient's financial information, approves medical Financial Assistance up to $2,000 value or recommends approval to supervisor when the amount exceeds $2,000.

- Determines the patient's ability to pay based on the analysis of the patient's financial information and negotiates and approves payment arrangements based on the patient's financial status.

- Provides functional guidance to the support staff and trains support staff and physicians on new or revised processes.

- Acts as a patient/member advocate and uses knowledge of external and internal social service agencies to accurately refer patients to social services.

- Retrospectively reviews diagnosis and treatment records to identify potential Third Party Liability and Workers Compensation cases.

- Refers identified cases to the Billing Department.

- Screens for potential eligibility for KP membership through Government Programs (Medi-Cal, Medicare, transition Plan, etc.) and refers to Member Services.

- Obtains pre-authorization for services from employers or other insurance carriers.

- Coordinates and collects conversion dues for KP.

- Checks patient information against updated eligibility using online systems.

- Places telephone calls to appropriate departments (Membership Accounting, Sales and Marketing, etc.).

- Ensures that all reviewed documentation in the billable jacket or on the superbill is complete and obtains any missing or needed information.

- Promotes, ensures, and improves customer service to internal and external customers by demonstrating skills consistent with the organization's philosophy of providing extraordinary customer relations and quality service.

Basic Qualifications:

Experience:

• Minimum of 2 years relevant experience (health care billing, collections) sufficient to analyze financial information to determine and negotiate financial arrangements.
• Experience in reviewing and analyzing financial information to assess ability to pay required.
• Experience with automated databases of PC systems required.
• Knowledge of workers compensation coordination of benefits and third party liability rules and regulations.
• Medical terminology and knowledge of health care billing practices required.
• Knowledge of registration, bill accounting, and collections required.
• Able to use RMIS, CARG, KPDS, OPAS, and ARRS.

Education:

• N/A

License, Certification, Registration:

• N/A

Additional Requirements:

• N/A

Preferred Qualifications:

• N/A

Notes:

• Schedule to include all shifts, rotating weekends, holidays, and floating within the established seniority section.