Financial Counselor

Kaiser Permanente; Lafayette (CO); On-site; USD 42,000 - 64,000; Full time

Job summary

Kaiser Permanente in Colorado is seeking a Financial Counselor to provide personalized counseling to members, patients, and customers related to payors, coverage, and enrollment. The role involves researching complex billing issues, explaining plans, and helping with payment arrangements.

Ideal candidates have healthcare billing experience, strong customer service skills, and knowledge of government and commercial programs.

Qualifications

• Minimum three (3) years of relevant experience in Health Care billing or health care collections required.
• Experience with healthcare business information systems.

Responsibilities

• Maintains understanding of Kaiser Permanente insurance products and answers questions from members regarding plans, benefits and enrollment processes.
• Assist in research of complex billing issues and meet timeframes while ensuring high-quality work.
• Convey estimates of member responsibility portion of billed cost and obtain missing information for deductibles, coinsurance, and copays.
• Interviews and pre-registers patient to determine payer source and eligibility; explains coverage and patient liability.
• Screen and inform members of healthcare financial assistance programs and assist with applications.
• Determines ability to pay and initiates payment plans; refer to social services as appropriate.
• Verifies pre-authorization and eligibility through government programs; confirms coverage and COB cases.

Skills

Customer service

Financial counseling

Healthcare billing

Medical terminology

Education

High School diploma

Tools

EMR systems

Job description

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Job Summary:

Under direct supervision, provides financial counseling to members/customers/patients in a personal interview to create a payer source for Inpatient and Outpatient self-pay accounts. Identifies potential Third Party liability, Compensation, Commercial, COB and Government programs. Provides a high level of direct customer service by assisting members/customers/patients with inquiries related to Health Plan enrollment to include premium and payment issues, benefits explanation, eligibility concerns and service recovery opportunities. This can include researching and analyzing a wide variety of complex issues and providing follow up. Verifies coverage, eligibility, pre-authorization, billing addresses and assists with collection of patient liability. Initiates payment plans as appropriate. Ensures all documentation is complete. Screens and directs correspondence, conducts periodic desk audits to identify backlogs and provides feedback to management. Makes members/customers/patients and their needs a primary focus of ones actions; develops and sustains productive member/customer/patient relationships. Actively seeks information to understand member/customer/patient circumstances, problems, expectations and needs. Builds rapport and cooperative relationship with members/customers/patients. Considers how actions or plans will affect members/customers/patients; responds quickly to meet member/customer/patient needs and resolves problems. The percentage of time working with members versus customers may vary depending on work location.

Essential Responsibilities:

• Maintains understanding of all Kaiser Permanente insurance products and answers questions from members/customers/patients regarding plans, products, benefits and enrollment processes.


• Assist in research of complex billing issues which may need follow up from other internal departments and meet timeframes for performance while balancing the need to provide high quality work related to complex and sensitive member/customer/patient issues.


• Convey estimates of the member/customer/patient responsibility portion of the billed cost of service. Ensures that all documentation is complete and obtains missing or needed information to members/customers/patients under deductible, coinsurance, and standard copay benefit designs based on established charge estimates for common procedures.


• Works with members/customers/patients in a friendly and knowledgeable manner to discuss, address and resolve their concerns regarding patient liability. Interviews and pre-registers patient to obtain/determine payer source, financial and demographic information, and obtain appropriate signatures. Works with members/customers/patients who may not understand their insurance coverage and the concept of patient liability. Makes decisions within policy. Documents member/customer/patients complaints.


• Has conversation about related patient liability regarding treatment in medical office/hospital setting. Works to cooperatively share/gather information on member/customer/patient liability and benefit issues. Screen and direct correspondence as needed.


• Determines members/customers/patients ability to pay and make payment arrangements and initiates payment plans as appropriate; identifies the member/customer/patient as medically indigent, and refers member/customer/patient to social services and/or other internal and external agencies as appropriate.


• Screens and inform members/customers/patients of various healthcare financial assistance programs, including payment plans, Kaiser Medical Financial Assistance, and government-sponsored programs. Assists members/customers/patients with application for Medical Financial Assistance.


• Verifies pre-authorization for services in cases where group eligibility is not updated or there is a potential for insurance fraud issues. Verifies eligibility for KP membership through government programs using online systems (Medicare, transition plan, etc). Verifies coverage on potential COB cases by calling insurance carriers.


• Provides functional guidance and informs internal customers and physicians on new and reviewed processes. Conducts periodic desk audits to identify backlogs and work queue issues. Provides feedback to management, as needed, for training requirements and updates. Trains staff regarding patient liability and benefit issues. If capacity allows, may assist in providing reports and performs other related duties as required.


• Provides clear and concise instructions to members/customers/patients for accessing KP website and other online tools. Assist non-English or limited-English speaking members/customers/patients in the use of interpreter services. Answer questions and manage members on existing/open Exchange cases.


• Acts as a liaison with Member Services, Patient Financial Services, Claims, the Consolidated Service Center, Medical Office Operations and other internal departments as well as demonstrates outstanding ability to be flexible and accommodating to varied requests from members/customers/patients, staff, physicians and leadership in order to provide answers to member/customer/patient questions and concerns. Research, resolve and communicate Health Plan/coverage-related assists for members/customers/patients. Use Kaiser Permanentes electronic medical record screens to track approval, denial, extension, etc. Identifies an alternate payer linkage or potential TPL or Workers Compensation cases; refer as appropriate. Works designated KP electronic medical record systems work queues, as assigned.

Basic Qualifications:

Experience

• Minimum three (3) years of relevant experience in Health Care billing (i.e. provider billing), Health Care collections, or health care clinic or hospital operations experience required.

Education

• High School graduation or General Education Development (GED) Diploma required.

License, Certification, Registration

• Medical Terminology Certification within 6 months of hire

Additional Requirements:

• Experience in reviewing and analyzing financial information to assess ability to pay required.


• Experience with healthcare business information systems.


• Experience in using a computer keyboard in performing assigned duties.


• Demonstrated customer service skills through prior work experience, customer focus abilities and the ability to understand Kaiser Permanente customer needs.


• Ability to demonstrate knowledge of and to utilize Government programs and alternate payer source (Workers Compensation, TPL,COB, Commercial, etc). Excellent verbal and written communication skills and interpersonal skills required.


• Excellent time management, personnel management, and organizational skills.


• Critical thinking, decision making and problem solving ability.


• Willingness to work in a Labor/Management Partnership environment required.


• Ability to communicate complex issues.


• Typing test 25 words per minute.

Preferred Qualifications:

• Experience in face to face, in person customer service interactions.