Financial Counselor

Job Summary:

This job exists to ensure that all patients' membership status and alternative payer information are accurately identified and documented. It also involves collecting or resolving all patient liabilities due at point-of-service, including insurance and government program co-payments, deductibles, shares of cost, and other amounts due at the time of service.

Under indirect supervision, the role provides financial counsel to patients in a personal interview regarding payer sources and/or health plan benefits. The following revenue-enhancing and member service functions will be accomplished:

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

Essential Responsibilities:

• Confidentially probes patients referred by staff such as inpatients/outpatient registration, department administrators, physicians, nursing, utilization management, and social workers about their problems concerning service coverage by an alternate payer.
• If the patient is determined to be ineligible, uses independent judgment to identify an alternate payer or classify the patient as medically indigent.
• Uses knowledge of Workers Compensation, Commercial Insurance Plans, Third Party Liability, outside agencies, and governmental regulations for government programs.
• Conducts patient interviews and observations, analyzes financial data, and reviews physician notes to accurately identify an alternate payer.
• Skillfully probes patients about their financial status, counsels, and makes arrangements for direct payment, status as indigent, potential enrollment in a government-sponsored program, or direct billing to the patient.
• If the patient is determined to be indigent and unable to qualify for any governmental program, completes a Kaiser Permanente Medical Financial Assistance application.
• Based on the analysis of the patient's financial information, approves medical Financial Assistance up to $2,000 or recommends approval to a supervisor when the amount exceeds $2,000.
• Determines the patient's ability to pay based on financial analysis and negotiates and approves payment arrangements based on the patient's financial status.
• Provides functional guidance to support staff and trains them on new/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, referring identified cases to the Billing Department.
• Screens for potential eligibility for Kaiser Permanente membership through Government Programs and refers to Member Services.
• Obtains pre-authorization for services from employers or other insurance carriers.
• Coordinates and collects conversion dues for Kaiser Permanente.
• Checks patient information against updated eligibility using online systems.
• Places telephone calls to appropriate departments to ensure 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/external customers by demonstrating skills consistent with the organization's philosophy of providing extraordinary customer relations and quality service.

Basic Qualifications:

Experience:

• Minimum of 3-4 years relevant experience in healthcare billing and collections sufficient to analyze financial information to determine/negotiate financial arrangements.
• Experience in reviewing and analyzing financial information to assess ability to pay is required.
• Experience with automated databases and PC systems is required.
• Knowledge of workers compensation coordination of benefits and third party liability rules and regulations.
• Medical terminology and knowledge of healthcare billing practices are required.
• Knowledge of registration, billing, accounting, and collections is required.
• Able to use RMIS, CARG, KPDS, OPAS, and ARRS.
• May be required to travel to multiple sites.
• Note: Education/License/Certification and qualifications required for Moreno Valley Community Hospital employees acquired through Kaiser Permanente's purchase of Valley Health Systems Moreno Valley Community Hospital: Employees shall meet the minimum position qualifications as listed on their previous Valley Health System job description.

Education:

• See Minimum Work Experience.

License, Certification, Registration:

• N/A

Additional Requirements:

Preferred Qualifications:

Notes:

• Rotating weekends.
• This is a temporary position for approximately three (3) months.