Financial Counselor

Kaiser Permanente; Ontario (CA); On-site; USD 30,000 - 41,000; Full time

Job summary

Kaiser Permanente in California is seeking a Financial Counselor to identify and document patients' membership status and payor information, guiding them through payment options and government programs as needed.

Under indirect supervision, you will counsel patients on billing, coverage, and alternative payors; coordinate with departments; and help resolve eligibility disputes while promoting excellent customer service.

Qualifications

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

Responsibilities

• Confer with patients to determine eligibility for alternate payors such as Non-member, COB, Third Party Liability, or government programs
• Identify ineligible patients and explore alternate payor options or indigence status
• Explain and coordinate payment arrangements and potential enrollment in government programs
• Refer identified cases to Billing Department and coordinate with departments as needed
• Train staff and physicians on new or revised financial processing procedures
• Advise patients and families on financial assistance options and document review outcomes

Skills

Healthcare billing

Collections

Financial analysis

Automated databases

Workers compensation

Third party liability

Medical terminology

Registration billing & collections

RMIS/CARG/KPDS/OPAS/ARRS

Tools

RMIS

CARG

KPDS

OPAS

ARRS

Job description

Job Summary:

This job exists to ensure that all patients membership status/alternative payor information is accurately identified & documented. Under indirect supervision, provides financial counsel to patients in a personal interview regarding payor sources and/or heath plan benefit. It will accomplish the following revenue enhancing & member service functions. Increase revenue through accurate & timely identification of membership status/alternative payors. Counsel patients on payment alternatives. Resolve any member/patient disputes regarding eligibility for service.

Essential Responsibilities:

This description is for recruitment posting purposes only. It has not received full HR review and approval.
- Confidentially probes patients who have been referred by staff such as inpatients/outpatient registration, department administrators, physicians, nursing, utilization management & 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 w/ 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, & governmental regulations for government programs; patient interview & observation; analysis of financial data; & physicians notes in order to accurately identify an alternate payor.
- Skillfully probes patients about their financial status, counsels & make arrangements for direct payment, status as an indigent, potential enrollment in a government sponsored program, or direct billing to patient.
- If the patient is determined to be indigent & not be able to qualify for any governmental program, completes a KP medical Financial Assistance application & based on analysis of patients financial information, approved medical; Financial Assistance up to $2,000 value or recommended approval to supervisor when amount exceeds $2,000.
- Determines patients ability to pay based on analysis of patients financial information & negotiates & approved payment arrangements based on patients financial status.
- Provides functional guidance to the support staff & trains support staff & physicians on new/revised process.
- Acts as a patient/member advocate & uses knowledge of external & internal social service agencies to accurately refer patients to social services.
- Retrospectively reviews diagnosis & treatment records to identify potential Third Party Liability & 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.) & refers to Member Services.
- Obtains pre-authorization for services from employers or other insurance carriers.
- Coordinates & collects conversion dues for KP.
- Checks patient information against update eligibility using on-line systems.
- Places telephone calls to appropriate departments (Membership Accounting, Sales & Marketing, etc.)
- Ensures that all reviewed documentation in the billable jacket or on the superbill is complete & obtains any missing or needed information.
- Promotes, ensures, & improves customer service to internal/external customers by demonstrating skills which are consistent w/ the organizations philosophy of providing extraordinary customer relations & quality service.

Basic Qualifications:

Experience

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

Education

• N/A

License, Certification, Registration

• N/A

Additional Requirements:

• N/A

Preferred Qualifications:

• N/A

Notes:

• Financial Counselor is to work in all admitting areas